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UNDERSTANDING MYELOMA

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UNDERSTANDING MYELOMA. Brian G.M. Durie, M.D. Chairman International Myeloma Foundation. Most Common Initial Problems. Bone pain Anemia/Fatigue NO Problems: Incidental finding during routine exam Kidney problem Other. Diagnosis. Imaging. Bone Marrow. Electro- pheresis. - PowerPoint PPT Presentation

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Page 1: UNDERSTANDING MYELOMA
Page 2: UNDERSTANDING MYELOMA

UNDERSTANDING MYELOMAUNDERSTANDING MYELOMA

Brian G.M. Durie, M.D.Brian G.M. Durie, M.D.ChairmanChairman

International Myeloma International Myeloma FoundationFoundation

Page 3: UNDERSTANDING MYELOMA

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

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Diagnosis

BoneMarrow

Imaging

Electro-pheresis

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Bone Lesions In MyelomaBone Lesions In Myeloma

Lytic lesions

Lytic lesions

LEG ELBOW

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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 /DLB – Creatinine B – Creatinine >> 2mg/DL 2mg/DL

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SOLITARY PLASMACYTOMA

T1-wt MRI STIR – wt MRI Sagittal CTSagittal FDG PET

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STAGING WITH FDG PET

FL on PET & MRI:Multiple Myeloma FDG PET: Severe Diffuse (D) and Focal (F) Disease

DDDD

DD

DD

DD

FF

FF

FF

FF

DD

MRI – STIR weighted of thoracic spine

FDG PET scanof thoracic spine

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Pretreatment 3 months later

Confirmation of Remission

Plasmacytomas

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MYELOMA PROTEIN “SPIKE”MYELOMA PROTEIN “SPIKE”

Low Albumin Spike

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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

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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

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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, AML1BWNT10B, ARHE, LNHR, SLAM, TACI, PIM1, IL6R, BIK, BAX, CFLAR

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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

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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 …

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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

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Next StepsNext Steps

HarvestingHarvesting ““Consolidation”Consolidation”

Auto stem cell transplantAuto stem cell transplant““Mini-allo”Mini-allo”

MaintenanceMaintenance

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Clear Recommendation Required

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Mutual Agreement is Essential

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MENTAL HEALTHMENTAL HEALTH

Stress reductionStress reduction Confidence in treatment planConfidence in treatment plan Expectation of remissionExpectation of remission Future plansFuture plans HOPEHOPE

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YOUR DOCTORYOUR DOCTOR

InformedInformed CooperativeCooperative Open to discussing optionsOpen to discussing options Caring for Caring for YOUYOU

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Caring and Trust are Crucial

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Help Others When You Can