UNDERSTANDING MYELOMA Brian G.M. Durie, M.D. Chairman International Myeloma Foundation.
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Transcript of UNDERSTANDING MYELOMA Brian G.M. Durie, M.D. Chairman International Myeloma Foundation.
UNDERSTANDING MYELOMAUNDERSTANDING MYELOMA
Brian G.M. Durie, M.D.Brian G.M. Durie, M.D.
ChairmanChairman
International Myeloma International Myeloma FoundationFoundation
Most Common Initial ProblemsMost Common Initial Problems
Bone painBone pain Anemia/FatigueAnemia/Fatigue NONO Problems: Incidental finding Problems: Incidental finding
during routine examduring routine exam Kidney problemKidney problem OtherOther
Bone Lesions In MyelomaBone Lesions In MyelomaBone Lesions In MyelomaBone Lesions In Myeloma
Lytic lesions
Lytic lesions
LEG ELBOW
StagingStaging
Single lesionSingle lesionSolitary plasmacytomaSolitary plasmacytomaStage IStage I
Multiple lesionsMultiple lesionsStages II / III A/BStages II / III A/B
A – Creatinine < 2mg /DLA – Creatinine < 2mg /DL
B – Creatinine B – Creatinine >> 2mg/DL 2mg/DL
STAGING WITH FDG PET
FL on PET & MRI:Multiple Myeloma FDG PET: Severe Diffuse (D) and Focal (F) Disease
DD
DD
DD
DD
DD
FF
FF
FF
FF
DD
MRI – STIR weighted of thoracic spine
FDG PET scanof thoracic spine
International Staging SystemInternational Staging System22M / S. AlbM / S. Alb
Stage 1Stage 1 Low Low 22M < 3.5M < 3.5** plusplus
S. AlbuminS. Albumin**** >> 3.5 G/DL 3.5 G/DL
Stage 2Stage 2 22M < 3.5 M < 3.5 butbut albumin < 3.5 albumin < 3.5
Or Or 22M or higher: 3.5 – < 5.5 M or higher: 3.5 – < 5.5
Stage 3Stage 3 High High 22M M >> 5.5mg/DL 5.5mg/DL
* mg/DL* mg/DL** Gm/DL** Gm/DL
Other FactorsOther Factors Impact of Impact of AGEAGE C-Reactive Protein (CRP)C-Reactive Protein (CRP) LDHLDH Chromosome 13Chromosome 13
Cytogenetic deletionCytogenetic deletionFISH analysisFISH analysis
Micro array classificationMicro array classification
Genetic Studies in Myeloma
Gene Array: Normal vs MM MM +/- Bone Disease
Sky Karyotype
No Lytic Lesions > 3 Lytic Lesions
Normal Bone MarrowCells
Clonally restricted PCw/o Chromosome 13 deletion
Clonally restricted PC w / Chr. 13 deletion
D13S31
D10S2142
anti-kappa
NPC MM
High
Gene Expression
Low
120 genes
NL Myeloma
CA13 – Tri-FISH
DKK1, FRZB, CENPA, TYMS, TTK, MAD2L1, PCNA, PRKDC, CCNF, AML1B
WNT10B, ARHE, LNHR, SLAM, TACI, PIM1, IL6R, BIK, BAX, CFLAR
Starting TreatmentStarting Treatment
Supportive Measures – for pain, Supportive Measures – for pain, anemia, infection …anemia, infection …
Systemic Therapy – oral and/or I.V. Systemic Therapy – oral and/or I.V. treatmenttreatment
Supportive CareSupportive Care
Bone – Aredia or ZometaBone – Aredia or Zometa Anemia – EPOAnemia – EPO Procrit/EpogenProcrit/Epogen Other – radiation, antibiotics, fluids, Other – radiation, antibiotics, fluids,
pain, medication …pain, medication …
First TherapyFirst TherapyInduction or FrontlineInduction or Frontline
Saving Stem CellsSaving Stem CellsVADVADDEXDEXThalidomide/DexamethasoneThalidomide/DexamethasoneCytoxanCytoxan
NOT NOT Saving Stem CellsSaving Stem CellsM/PM/POther combosOther combos
Next StepsNext Steps
HarvestingHarvesting ““Consolidation”Consolidation”
Auto stem cell transplantAuto stem cell transplant““Mini-allo”Mini-allo”
MaintenanceMaintenance
MENTAL HEALTHMENTAL HEALTH
Stress reductionStress reduction Confidence in treatment planConfidence in treatment plan Expectation of remissionExpectation of remission Future plansFuture plans HOPEHOPE
YOUR DOCTORYOUR DOCTOR
InformedInformed CooperativeCooperative Open to discussing optionsOpen to discussing options Caring for Caring for YOUYOU