![]() ![]() Progressive, responding to treatment, or getting worse. Time, when it is necessary to decide whether the disease is stable or These initial studies are often compared with subsequent values at a later Primary plasma cell leukemia has a particularly poor prognosis. The presence of circulating myeloma cells is considered a poor prognosticįactor.Measure serum albumin and beta-2-microglobulin as independent.If amyloidosis is suspected, perform a needle aspiration of subcutaneousĪbdominal fat and stain the bone marrow biopsy for amyloid as the easiest and.At diagnosis, whole-body PET scan or MRI of the total spine and pelvis appears to be equally efficacious in the detection of bone lesions. Obtain a spinal magnetic resonance imaging (MRI) scan (or spinal computed tomography or positron emission tomography –CT scan depending on availability) if the skeletal survey is negative.Obtain radiographs of the skull, ribs, vertebrae, pelvis, shoulder girdle,.Measure serum levels of calcium, alkaline phosphatase, lacticĭehydrogenase, and, when indicated by clinical symptoms, cryoglobulins and. ![]() Larger light-chain peak in the globulin region this tubular pattern is the Lesions, the typical electrophoresis pattern shows a small albumin peak and a ![]() This leads to precipitation of proteins and theįormation of tubular casts, which may injure the tubular cells. The concentration of protein in the tubules increasesĪs water is reabsorbed. In most myeloma patients, the glomeruli function normally allows only the small molecular weight proteins, such as light chains, toįilter into the urine. Into the urine the electrophoresis pattern of this urine resembles the serum Such as those resulting from glomerular deposits of amyloid or light-chainĭeposition disease, result in the nonselective leakage of all serum proteins Electrophoresis of concentrated urine protein is very helpful inĭifferentiating glomerular lesions from tubular lesions. ![]() Evaluate renal function with serum creatinine and a creatinine clearance.Tumor(s), or enlarged lymph node(s) to determine whether these are If clinically warranted, obtain needle aspirates of a solitary lytic bone lesion, extramedullary.The FLC ratio of over 100 can predict a greater than 70% progression within 2 years in patients with smoldering myeloma. This is especially useful in cases of oligosecretory plasma-cell dyscrasia or for following cases of light-chain amyloidosis. Measure serum-free kappa and lambda light chains.For more information, see the Genetic factors and risk groups section. Bone marrow is often sent for cytogenetics and fluorescence in situ hybridization testing for genetic markers of high-risk disease. Be aware that marrow plasma-cell distribution may vary in different sites. Determine the percentage of marrow plasma cells.Measure the hemoglobin, leukocyte, platelet, and differential counts.Identify the heavy and light chain of the M protein by immunofixation electrophoresis.An easier, but less accurate, method uses a spot-urine protein electrophoresis. M protein, as determined by electrophoresis of concentrated urine protein. Hours and multiply this value by the percentage of urine protein that is Measure the total amount of protein excreted over 24 Measure and follow the amount of M protein light chains excreted in the.Quantitative serum-free light chains (FLC) may be helpful to follow response when an M protein is not apparent. For this reason, the preference is often that baseline andįollow-up measurements of the M protein be done by the same method. Measure and follow the serum M protein by serum electrophoresis or by specific immunoglobulin (Ig) assays however, specific Ig quantification always overestimates the M protein because normal.Patients with an M protein in the serum and/or urine are evaluated by some of the following criteria: Treatment from patients with progressive, symptomatic myeloma who may need to be To separate the stable asymptomatic group of patients who do not require Immediate treatment but must be followed carefully for signs of disease Patients with MGUS or asymptomatic smoldering myeloma do not require Systemic treatment must be considered for all patients with symptomatic For this reason, when treatment is indicated, Idiotypic myeloma cells can be found in the blood of myeloma patients in all IgG kappa or lambda or IgA kappa or gammaĮvaluation of patients with monoclonal (or myeloma) protein (M protein) Solitary lesion of soft tissue most commonly occurs in the nasopharynx, tonsils, or paranasal sinuses Solitary lesion of bone <10% plasma cells in marrow of uninvolved site Ig = immunoglobulin MGUS = monoclonal gammopathy of undetermined significance.Īsymptomatic, with minimal evidence of disease (aside from the presence of an M protein) Clinical Presentation of Plasma Cell Neoplasms Plasma Cell Neoplasm Clinical Presentation and Evaluation Table 1. ![]()
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