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smoldering myeloma
Definition:
- presence of monoclonal paraprotein (an M-spike of >3 g/dL) or free light chain (Bence Jones protein) in the urine > 500 mg/24 hours
- bone-marrow plasmacytosis greater than 10%-59%, or both
- absence of symptoms, anemia, lytic bone lesions, hypercalcemia, or renal insufficiency
Complications:
- progression to active muliple myeloma or to AL-amyloidosis (57% overall)
- 10% yearly during years 1 to 5
- 3% yearly during years 6 to 10
- 1% yearly thereafter
- 5-year median rates of disease progression
- 15% for the M-spike-only
- 43% for >10%-plasmacytosis-only
- 69% for the group with both
Laboratory:
- complete blood count (CBC)
- no anemia
- serum calcium: no hypercalcemia
- serum creatinine: no renal insufficiency
- serum protein electrophoresis
- serial evaluation every 3-6 months
Radiology:
- radiographic survey, including long bones & skull
- may detect lytic lesions
- whole body MRI if radiology negative to evaluate smoldering multiple myeloma
- no lytic lesions
- bone scan not recommended [2]
- multiple myeloma lesions are often purely lytic
- a bone scan detects osteoblastic lesions
Management:
- observe, do not treat
- evaluation every 3-6 months
Interactions
disease interactions
General
multiple myeloma; plasmacytoma/plasma cell myeloma
References
- Kyle RA et al.
Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma.
N Engl J Med 2007 Jun 21; 356:2582-90
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19
American College of Physicians, Philadelphia 2015, 2018, 2022
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022