A new risk stratification magic size is provided to specifically define high-risk patients who may benefit from novel therapeutic strategies

A new risk stratification magic size is provided to specifically define high-risk patients who may benefit from novel therapeutic strategies. addition, either is essential if spinal cord compression is definitely suspected. Role of the serum FLC assay The serum FLC assay offers three main uses. First, it has prognostic value in MM,2 monoclonal gammopathy of undetermined significance (MGUS),3 smoldering MM (SMM)4 and solitary plasmacytoma of bone.5 Second, it can be used in conjunction with serum protein electrophoresis and immunofixation when screening for the presence or absence of a monoclonal plasma cell disorder such as myeloma in place of a 24-h urine protein study. However, if a plasma cell proliferative disorder is definitely diagnosed, then a 24-h urine protein electrophoresis and immunofixation are needed, and the serum FLC assay cannot be used in place of urine studies. Finally, the serum FLC test is useful in monitoring disease program and response to therapy in individuals who do not have measurable disease on serum and protein electrophoresis (including non-secretory myeloma). Measurable disease is definitely defined as serum monoclonal (M) protein 1 g/100 ml or urine M protein 200 mg per 24 h. In individuals without measurable disease, you will find few options available to monitor disease and the FLC levels will become useful as explained in the section below on response criteria. Diagnostic criteria Standard diagnostic criteria The International Myeloma Working Group (IMWG) and Mayo Medical center have established almost identical criteria for the analysis of the plasma cell proliferative disorders.6 Table 2 lists the current IMWG diagnostic criteria for MM with minor clarifications (as referenced); it also lists the diagnostic criteria for related plasma cell disorders that need to be differentiated from MM. MGUS is definitely defined by an intact immunoglobulin 3 g/100 ml and 10% bone marrow plasma cells and absence of end-organ damage. End-organ damage includes hyperreduction in 24 h urine M protein by Rabbit Polyclonal to FMN2 50C89%, which still exceeds 200 mg per 24 hIn addition to the above criteria, if present at baseline, 25C49% reduction in the size of soft cells plasmacytomas is also requiredNo increase in size or quantity of lytic bone lesions (development of compression fracture does not exclude response)Progression to active myeloma in individuals with smoldering myelomaEvidence of progression based on the IMWG criteria for progressive disease in myeloma (Table 5) em and /em Any one or more of the following felt related to the underlying clonal plasma cell proliferative disorder?Development of new soft cells plasmacytomas or bone lesions?Hypercalcemia ( 11 mg/100 ml)?Decrease in hemoglobin of 2 g/100 ml?Serum creatinine level 2 mg/100 Indeglitazar ml Open in a separate windowpane Abbreviation: IMWG, International Myeloma Working Group. Adapted with permission from Anderson em et al /em .30 Survival estimates Several estimates of survival such as overall survival, disease-free survival, progression-free survival, time to progression and event-free survival are used to describe outcome in myeloma. The specific definitions of these terms and their respective part in myeloma are outlined in Table 7. Table 7 Definitions Indeglitazar of time to event end points30 thead th align=”remaining” rowspan=”1″ colspan=”1″ End point /th Indeglitazar th align=”remaining” rowspan=”1″ colspan=”1″ Definition /th th align=”remaining” rowspan=”1″ colspan=”1″ Comment /th /thead Time to progression (TTP)Period from start of treatment to disease progression, with deaths due to causes other than progression censoredTTP is useful in assessing the activity of a drug and the durability of treatment benefit, but does not take into account the fact that a treatment may be associated with improved treatment-related deaths and hence should be assessed in conjunction with progression-free survivalProgression-free survival (PFS)Period from start of the treatment to disease progression or death (no matter cause of death),.