Overview
Plasma cell myeloma (PCM) is a hematologic malignancy characterized by clonal proliferation of plasma cells in the bone marrow, often leading to bone lesions, hypercalcemia, renal failure, and immunodeficiency. 1Diagnosis
Serum and urine monoclonal protein (M-protein) detection 1
Bone marrow biopsy showing clonal plasma cells ≥10% 1
Evidence of end-organ damage (CRAB: hyperCalcemia, Renal insufficiency, Anemia, Bone lesions) 1
Imaging studies (MRI, CT) to assess bone lesions 1
Genetic testing for specific mutations (e.g., t(4;14), t(14;16)) 1Management
First-line treatment: Bortezomib-based regimens (e.g., bortezomib, lenalidomide, dexamethasone) 1
Autologous hematopoietic stem cell transplantation (HSCT): Considered for eligible patients post-induction therapy 1
Angiogenesis modulation: Monitoring Ang1/Ang2 ratio to assess endothelial stability during HSCT may guide supportive care 1
Supportive care: Management of bone turnover markers (e.g., TRACP-5b, CTX, bALP) to prevent fractures and manage bone health 1Special Populations
HSCT considerations: Significant changes in bone metabolism and angiogenesis markers observed; close monitoring recommended 1
No specific data: Limited information on pregnancy, pediatrics, or elderly-specific management in provided abstracts 1Key Recommendations
Monitor bone turnover markers (TRACP-5b, CTX, bALP) and Ang1/Ang2 ratio during high-dose chemotherapy and HSCT to guide supportive care strategies (Evidence: Moderate) 1
Consider autologous HSCT in eligible patients following induction therapy for improved outcomes (Evidence: Expert opinion) 1
Utilize bortezomib-based regimens as first-line treatment due to efficacy in managing PCM (Evidence: Moderate) 1References
1 Boutsikas G, Terpos E, Papatheodorou A, Tsirkinidis P, Tsirigotis P, Meletiou A et al.. Study of bone metabolism and angiogenesis in patients undergoing high-dose chemotherapy/autologous hematopoietic stem cell transplantation. European journal of haematology 2018. link