Multiple myeloma survey

張貼日期：2019/7/24 上午 08:23:43

Screen:

• Check serum total protein, albumin, Ca2+, LDH, IgA, IgG, IgM, serum protein electrophoresis, IFE, kappa free light chain, lambda free light chain, beta-2 microglobulin
• Check urine(24 hour): electrophoresis, IFE, total protein
• Arrange bone survey(X-ray)
• BM study(A+B+C+F) is indicated

Diagnosis of multiple myeloma

• Myeloma defining event(7取1) + marrow clonal plasma cells(BM plasma cells > 10% or plasmacytoma)
• Bloodref連結

Treatment

• (Commonly) TCD before velcade available
• Bisphosphonate (ex: pamidronate) 90 mg IF QM
• Arrange plasma exchange (if hyperviscosity syndrome, IgM > 4 g/dl, IgG > 5 g/dL, IgA > 7 g/dL)

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Optional:

• Arrange fat pad or rectum biopsy (if amyloidosis is suspected)
• Check serum HbsAg, anti-Hbs, anti-HBc, anti-HCV (before treatment start)