Suggest treatment for plasma cell neoplasms
Flow cytometry performed demonstrates a kappa light chain excess among polytypic plasma cells with a subset demonstrating immunophenotypic aberrancy. These findings are reported as highly suspicious for plasma cell neoplasm in a background of normal plasma cells. This population cannot be definitely identified by light microscope methods.
HISTORY OF PRESENT ILLNESS: The patient is a 47 YO with no past medical history. noted to
have low bone density five years ago and repeat one again showed low bone density. SPEP show 09 g/dL M spike. White count ls 4.3. hemoglobin 14 3. and platelets 265.000. Creatinine 1.1 and IgG of 1468.
lgA 93. IgM 114 UPEP. urine protein lmmunoflxation negative and serum immunoflxation shows 196
kappa and kappa chain is 13. lambda is 8.69. kappa to lambda 1.50. We will order a skeletal survey and also bone marrow aspiration and biopsy and regroup in 10 days. However. i do not see any end-organ damage at this point, He probably has MGUS. No significant other symptoms,
WBC 3.7, RBC 4.56, HGB 13.9, HCT 41.4, MCV 90.8, MCH 30.4, MCHC 33.5, RDW 13.3, PLT 217 ,MVP 217 ANC 0
PAST MEDICAL HISTORY: No diabeles or hypertension, No heart problems.
2. Wisdom teeth extraction.
MEDICATIONS: Vyvanse and vitamin D and calcium.
SOCIAL HISTORY: No smoking. Drlnks alcohol almost 5 days a week. Married. Has three children and Lives In XXXXXXX Self-employed.
FAMILY HISTORY: Mother had heart valve replacement. She is on Coumadin. Father has stroke.
hypertension. diabetes. and has almost 14 half siblings. one half brother died of leukemia. Paternal
grandfather has skin cancer. Grand father liver cancer.
ALLERGIES: No known drug allergies.
REVIEW OF SYSTEMS:
CONSTITUTIONAL: No fever. chills. or night sweats. No loss ofweight or appetite.
CARDIOVASCULAR: No shortness of breath, chest pain. PND. orthopnea. palpitations.
RESPIRATORY: No lever. cough, or mucoid sputum
GASTROINTESTINAL: No abdominal pain. nausea. vomiting. homelemeels. or mslena.
NEUROLOGICAL: No headaches. dlplopia. seizures. loss ofconsciousness.
ENDOCRINE: No heat or cold intolerance.
HEENT: There is no pallor icterus.
LUNGS: Clear. No palpable adenopathy.
HEART: SI and S2 heard, No murmur or gallop.
ABDOMEN: Soft. non-tender. Bowel Bounds positive,
EXTREMITIES: No edema.
LABORATORY RESULTS: White count 5.9, hemoglobin 14.8, and platelets 277,000. Creatinine 1.1,
Sodium 138. potassium 4.3. chloride 101, calcium 9.4.
IMPRESSION AND RECOMMENDATIONS: A 47 YO M with no past medical history. has M-protein of 1gIdL CBC normal. Calcium and creatlnin is normal. SPEP shows a g/dL lgG kappa. UPEp and urine immunofixation is negative. Quantitative Immunoglohulins are normal. At this point. no end-organ damage noted. We will check a bone marrow aspiration and biopsy and skeletal survey and will see him back within 10 days. Most likely he has MGUS.
Hello dear. The patient has smoldering myeloma.
Hello dear. Welcome to HCM. I have gone through the details. The patient is suffering from plasma cell neoplasm and fits into the category of smoldering myeloma(plasma cells in marrow more than 10 percent defines myeloma).
However , i donot see any indication for the treatment as he does not fullfil(CRAB) criteria except that bony lesion require evaluation by atleast a skeletal survey( a PETscan or MRI would be better choice). Moreover the pathologist is right in saying , it is a plasma cell neoplasm and not MGUS.
He however require skeletal evaluation. Repeat marrow is not indicated.
Thanks and regards
Hello dear. Skeletal survey is normal.
Hello dear. Your skeletal survey is normal. The rate of conversion of smoldering myeloma to active disease is 10 percent per year. Means 10 out of 100 patient will turn to active er year. At present no treatment is recommended at your stage so actually i have no data of such patients getting prevented from development of active disease.
Hello dear. It is smoldering myeloma by definition. and not MGUS
HEllo dear. By definition, you have a smoldering myeloma. Any plasma cells beyond 10 percent in marrow in the absence of CRAB CRITERIA is either a smoldering myeloma or a high risk smoldering myeloma but definitely not MGUS.
Moreover, a FLC ratio has nothing to do with the diagnosis of MGUS
However, an abnormal flc ratio (involved/uninvolved more than 60)qualifies for the diagnosis of high risk smoldering myeloma. So by looking at FLC ratio we can decide whether you have smoldering type or not. IF it is even higher , more than 100 then you have active myeloma.
Similarly if a PET or MRI shows active lesions, as they are more sensitive than skeletal survey, you require treatment as active active myeloma.
But for all practical purposes you donot have MGUS.
clonality has nothing to do to differentiate between MGUS and Smoldering myeloma.
Now the crux is
you require treatment only if
1. you fullfill any of CRAB
2. you have an abnormal flc of 100 or more
3. you have high viscosity
4. repeated pulmonary infections
6. 2 or more lesions on petct.
If you donot have any of these, you have smoldering myeloma and just require observation till you develop any of these.
Thanks and regards
I dnt want to argue with your physician, but this is all what is evidence based and i can guarantee this.
Hello. Thanks and regards
Feel free to ask further. Thanks and regards
Hello dear. I have confirmed. It is smoldering myeloma.
Hello dear. Welcome once again. I am referring you to the latest guidelines of NCCN(NAtional cancer cooperative network) which I follow in my clinical practice. As per these guidelines, it fits into the category of smoldering myeloma.
Nothing to do with monoclonal or polyclonal for determining smoldering versus MGUS and FISH is not used to diagnose MGUS vs smoldering myeloma. Moreover myeloma is always monoclonal for all practical purposes, rarely it can be polyclonal.
It is for certain not ALL. Mark my words.
Rest assured. and relax. You do not need treatment as of now.
The User accepted the expert's answer
Get personalised answers from verified doctor in minutes across 80+ specialties
- Treatment and cure for plasma cell balanitis
- Treatment and cure for plasma cell vulvitis
- Treatment and cure for plasma cell dyscrasias
- Suggest treatment for ocd treatment
- Is decadron used in the treatment of plasma cell myeloma ?
- Is pomalyst used in the treatment of cancer, plasma cell myeloma ?
- Treatment and cure for plasma cell disorders
- What is plasma cell dyscrasia
- Plasma cell vulvitis causes
- Treatment and cure for plasma cell cancer