Myeloma
Diagnosis and staging
In asymptomatic (‘smouldering’) myeloma there is generally a serum monoclonal protein >30 g/L and/or bone marrow clonal plasma cells >10% but no related organ or tissue impairment (Figs 31.1 and 31.2). A diagnosis of symptomatic myeloma requires evidence of such impairment; typically increased calcium, renal insufficiency, anaemia, or bone lesions (Table 31.1 and Fig 31.3). Bony disease is increasingly assessed by MRI scanning in addition to traditional X-rays (‘skeletal survey’) (Fig 31.4). Patients who have a paraprotein in the serum but who do not meet the criteria for myeloma are diagnosed as having MGUS. They have a rate of progression to myeloma of 1% per year. Monoclonal gammopathy is associated with other diseases such as lymphoma, non-haematopoietic malignancies and connective tissue disorders but it is also quite common in healthy elderly people (approximately 5% over 70 years of age).
Table 31.1
Diagnostic criteria for symptomatic myeloma