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UNDERSTANDING MYELOMA

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.

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UNDERSTANDING MYELOMA

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  1. UNDERSTANDING MYELOMA Brian G.M. Durie, M.D. Chairman International Myeloma Foundation

  2. Most Common Initial Problems • Bone pain • Anemia/Fatigue • NO Problems: Incidental finding during routine exam • Kidney problem • Other

  3. Diagnosis Imaging Bone Marrow Electro- pheresis

  4. Lytic lesions Bone Lesions In Myeloma Lytic lesions LEG ELBOW

  5. Staging • Single lesion • Solitary plasmacytoma • Stage I • Multiple lesions • Stages II / III A/B A – Creatinine < 2mg /DL B – Creatinine > 2mg/DL

  6. SOLITARY PLASMACYTOMA Sagittal CT Sagittal FDG PET T1-wt MRI STIR – wt MRI

  7. Multiple Myeloma FDG PET: Severe Diffuse (D) and Focal (F) Disease F F D F D F D D D D STAGING WITH FDG PET • FL on PET & MRI: FDG PET scan of thoracic spine MRI – STIR weighted of thoracic spine

  8. Confirmation of Remission Plasmacytomas Pretreatment 3 months later

  9. MYELOMA PROTEIN “SPIKE” Low Albumin Spike

  10. International Staging System2M / S. Alb * mg/DL ** Gm/DL

  11. Other Factors • Impact of AGE • C-Reactive Protein (CRP) • LDH • Chromosome 13 • Cytogenetic deletion • FISH analysis • Micro array classification

  12. anti-kappa D13S31 D10S2142 DKK1, FRZB, CENPA, TYMS, TTK, MAD2L1, PCNA, PRKDC, CCNF, AML1B WNT10B, ARHE, LNHR, SLAM, TACI, PIM1, IL6R, BIK, BAX, CFLAR Genetic Studies in Myeloma Sky Karyotype CA13 – Tri-FISH Clonally restricted PC w/o Chromosome 13 deletion Normal Bone Marrow Cells Clonally restricted PC w / Chr. 13 deletion Gene Array: Normal vs MM MM +/- Bone Disease NL Myeloma No Lytic Lesions > 3 Lytic Lesions NPC MM Gene Expression High Low 120 genes

  13. Starting Treatment • Supportive Measures – for pain, anemia, infection … • Systemic Therapy – oral and/or I.V. treatment

  14. Supportive Care • Bone – Aredia or Zometa • Anemia – EPO Procrit/Epogen • Other – radiation, antibiotics, fluids, pain, medication …

  15. First TherapyInduction or Frontline • Saving Stem Cells • VAD • DEX • Thalidomide/Dexamethasone • Cytoxan • NOT Saving Stem Cells • M/P • Other combos

  16. Next Steps • Harvesting • “Consolidation” • Auto stem cell transplant • “Mini-allo” • Maintenance

  17. Clear Recommendation Required

  18. Mutual Agreement is Essential

  19. MENTAL HEALTH • Stress reduction • Confidence in treatment plan • Expectation of remission • Future plans • HOPE

  20. YOUR DOCTOR • Informed • Cooperative • Open to discussing options • Caring for YOU

  21. Caring and Trust are Crucial

  22. Help Others When You Can

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