MKSAP multipel myeloom

 

Met Reinier Raymakers. Ter voorbereiding op het MKSAP onderwijs van woensdag 29 november 2017. Zie deze pagina voor aanvullende definities en diagnostisch stroomdiagram.

Definition for multiple myeloma (Revised International Myeloma Working Group criteria):

  • Clonal bone marrow plasma cells ≥10% of biopsy-proven bony or extramedullary plasmacytoma and any one or more of the following myeloma-defining events:
    • Evidence of end-organ damage that can be attributed to the underlying plasma cell proliferative disorder, specifically:
    • Hypercalcemia: serum calcium >0.25 mmol/L (>1 mg/dL) higher than the upper limit of normal or >2.75 mmol/L (>11 mg/dL)
    • Renal insufficiency: creatinine clearance <40 mL per min or serum creatinine >177 µmol/L (>2 mg/dL)
    • Anemia: hemoglobin value of >20 g/L below the lower limit of normal, or a hemoglobin value <100 g/L
    • Bone lesions: one or more osteolytic lesions on skeletal radiography, CT, or PET-CT
  • Or any one or more of the following biomarkers of malignancy:
    • Clonal bone marrow plasma cell percentage ≥60%
    • Involved:uninvolved serum free light chain ratio ≥100
    • >1 focal lesions on MRI studies

Definition of smoldering multiple myeloma (both criteria must be met):

  • Serum monoclonal protein (IgG or IgA) ≥30 g/L or urinary monoclonal protein ≥500 mg per 24 hours and/or clonal bone marrow plasma cells 10 to 60%
  • Absence of myeloma defining events or amyloidosis

 

Definition of monoclonal gammopathy of undetermined significance (all three criteria must be met):

  • Serum monoclonal protein <30 g/L
  • Bone marrow plasma cells <10%
  • Absence of myeloma defining events or amyloidosis (or Waldenström macroglobulinemia in the case of IgM MGUS)

 

Zie ook dit UpToDate stroomdiagram m.b.t. diagnostiek bij verdenking op multipel myeloom.

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