understanding myeloma
DESCRIPTION
UNDERSTANDING MYELOMA. Brian G.M. Durie, M.D. Chairman International Myeloma Foundation. Most Common Initial Problems. Bone pain Anemia/Fatigue NO Problems: Incidental finding during routine exam Kidney problem Other. Diagnosis. Imaging. Bone Marrow. Electro- pheresis. - PowerPoint PPT PresentationTRANSCRIPT
UNDERSTANDING MYELOMAUNDERSTANDING MYELOMA
Brian G.M. Durie, M.D.Brian G.M. Durie, M.D.ChairmanChairman
International Myeloma International Myeloma FoundationFoundation
Most Common Initial ProblemsMost Common Initial Problems
Bone painBone pain Anemia/FatigueAnemia/Fatigue NONO Problems: Incidental finding Problems: Incidental finding
during routine examduring routine exam Kidney problemKidney problem OtherOther
Diagnosis
BoneMarrow
Imaging
Electro-pheresis
Bone Lesions In MyelomaBone Lesions In Myeloma
Lytic lesions
Lytic lesions
LEG ELBOW
StagingStaging
Single lesionSingle lesionSolitary plasmacytomaSolitary plasmacytomaStage IStage I
Multiple lesionsMultiple lesionsStages II / III A/BStages II / III A/B
A – Creatinine < 2mg /DLA – Creatinine < 2mg /DLB – Creatinine B – Creatinine >> 2mg/DL 2mg/DL
SOLITARY PLASMACYTOMA
T1-wt MRI STIR – wt MRI Sagittal CTSagittal FDG PET
STAGING WITH FDG PET
FL on PET & MRI:Multiple Myeloma FDG PET: Severe Diffuse (D) and Focal (F) Disease
DDDD
DD
DD
DD
FF
FF
FF
FF
DD
MRI – STIR weighted of thoracic spine
FDG PET scanof thoracic spine
Pretreatment 3 months later
Confirmation of Remission
Plasmacytomas
MYELOMA PROTEIN “SPIKE”MYELOMA PROTEIN “SPIKE”
Low Albumin Spike
International Staging SystemInternational Staging System22M / S. AlbM / S. Alb
Stage 1Stage 1 Low Low 22M < 3.5M < 3.5** plusplus
S. AlbuminS. Albumin**** >> 3.5 G/DL 3.5 G/DL
Stage 2Stage 2 22M < 3.5 M < 3.5 butbut albumin < 3.5 albumin < 3.5 Or Or 22M or higher: 3.5 – < 5.5 M or higher: 3.5 – < 5.5
Stage 3Stage 3 High High 22M M >> 5.5mg/DL 5.5mg/DL
* mg/DL* mg/DL** Gm/DL** Gm/DL
Other FactorsOther Factors Impact of Impact of AGEAGE C-Reactive Protein (CRP)C-Reactive Protein (CRP) LDHLDH Chromosome 13Chromosome 13
Cytogenetic deletionCytogenetic deletionFISH analysisFISH analysis
Micro array classificationMicro array classification
Genetic Studies in Myeloma
Gene Array: Normal vs MM MM +/- Bone Disease
Sky Karyotype
No Lytic Lesions > 3 Lytic Lesions
Normal Bone MarrowCells
Clonally restricted PCw/o Chromosome 13 deletion
Clonally restricted PC w / Chr. 13 deletion
D13S31 D10S2142
anti-kappa
NPC MM
High
Gene Expression
Low
120 genes
NL Myeloma
CA13 – Tri-FISH
DKK1, FRZB, CENPA, TYMS, TTK, MAD2L1, PCNA, PRKDC, CCNF, AML1BWNT10B, ARHE, LNHR, SLAM, TACI, PIM1, IL6R, BIK, BAX, CFLAR
Starting TreatmentStarting Treatment
Supportive Measures – for pain, Supportive Measures – for pain, anemia, infection …anemia, infection …
Systemic Therapy – oral and/or I.V. Systemic Therapy – oral and/or I.V. treatmenttreatment
Supportive CareSupportive Care
Bone – Aredia or ZometaBone – Aredia or Zometa Anemia – EPOAnemia – EPO Procrit/EpogenProcrit/Epogen Other – radiation, antibiotics, fluids, Other – radiation, antibiotics, fluids,
pain, medication …pain, medication …
First TherapyFirst TherapyInduction or FrontlineInduction or Frontline
Saving Stem CellsSaving Stem CellsVADVADDEXDEXThalidomide/DexamethasoneThalidomide/DexamethasoneCytoxanCytoxan
NOT NOT Saving Stem CellsSaving Stem CellsM/PM/POther combosOther combos
Next StepsNext Steps
HarvestingHarvesting ““Consolidation”Consolidation”
Auto stem cell transplantAuto stem cell transplant““Mini-allo”Mini-allo”
MaintenanceMaintenance
Clear Recommendation Required
Mutual Agreement is Essential
MENTAL HEALTHMENTAL HEALTH
Stress reductionStress reduction Confidence in treatment planConfidence in treatment plan Expectation of remissionExpectation of remission Future plansFuture plans HOPEHOPE
YOUR DOCTORYOUR DOCTOR
InformedInformed CooperativeCooperative Open to discussing optionsOpen to discussing options Caring for Caring for YOUYOU
Caring and Trust are Crucial
Help Others When You Can