Multiple myeloma
(Plasma cell myeloma, medullary plasmacytoma)

  • Method:
  • Anticoagulant:
  • Recommendation:
  • Method:
    Cytomorphology
  • Anticoagulant:
    EDTA
  • Recommendation:
    obligatory
  • Method:
    Immunophenotyping
  • Anticoagulant:
    EDTA or Heparin
  • Recommendation:
    facultative
  • Method:
    Chromosome analysis
  • Anticoagulant:
  • Recommendation:
    no
  • Method:
    FISH
  • Anticoagulant:
    EDTA or Heparin
  • Recommendation:
    obligatory*
  • Method:
    Molecular genetics
  • Anticoagulant:
    EDTA or Heparin
  • Recommendation:
    facultative

* after CD138+ sorting

Based on the current guidelines and the current state of research, there are different diagnostic recommendations for patients with multiple myeloma. We have summarized the most important information on the classification and diagnostic methods at MLL. In addition, we have compiled further links on prognosis and therapy in multiple myeloma, so that you can inform yourself in more detail.

Multiple myeloma: Classification and staging

According to the 2017 WHO-classification, multiple myeloma belongs to the group of plasma cell neoplasms within mature B-cell neoplasms (Swerdlow et al. 2017).

The International Staging System (ISS, 2005 – ISS-Score) and the Revised ISS (R-ISS/2015 – R-ISS-Score) of the International Myeloma Working Group IMWG are used for staging. In addition to serum parameters, the R-ISS also includes cytogenetic risk factors (see below).

Multiple Myeloma: Diagnostic methods and their relevance

Multiple Myeloma: Prognosis

The prognostic factors mentioned so far (ISS/R-ISS, cytogenetics) have been validated mainly in the context of newly diagnosed MM, and their prognostic significance is largely maintained during the course of therapy and disease (Pawlyn & Davies 2019). In addition, other factors include MRD negativity and duration of relapse-free survival.

Multiple Myeloma (MM): Prognosis calculation

Click here to access the prognosis calculation of the ISS score and the R-ISS score. The risk of progression from MGUS to myeloma or lymphoproliferative disease can be estimated using the MGUS-Prognosis-Score.

Multiple Myeloma: Therapy

Guidelines on therapy can be found from Dimopoulos et al. (EHA-ESMO Guidelines, Dimopoulos et al. 2021) and on the Onkopedia website (Onkopedia Guideline Multiple Myeloma), among others.

Recommendation

Due to artifacts, dilution by peripheral blood or focally different infiltration, cytomorphological and flow cytometric assessment of bone marrow aspirates may underestimate the true plasma cell infiltration. Therefore, according to recommendations of the European Myeloma Network (EMN), an additional bone marrow biopsy should be performed (Caers et al. 2018). If there are discrepancies in the determination of plasma cell infiltration on biopsy and aspirate, the IMWG consensus is that the higher of the two values should be used (Rajkumar et al. 2014).

Status: March 2022

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