Routinediagnostik

Beachte: Abklärung MGUS

Blutuntersuchungen

        • Myelom Block
          • Diagnose
          • Zyklustag 1
          • Responsebeurteilung
        • Routine Block
          • 1x/ Woche unter Therapie

Harnuntersuchungen

        • 24h Sammelurin
          • Diagnose
          • Responsebeurteilung
        • Spontanharn
          • Zyklustag 1

Knochenmarkbiopsie

        • Diagnose
        • Responsebeuteilung

Zytogenetik

        • Diagnose

FISH

        • Diagnose

Skelettröntgen

        • Diagnose
        • Responsebeurteilung
        • Symptomatik

MR - Wirbelsäule,Becken

        • Diagnose
        • Symptomatik

Nervenleitgeschwindigkeit

        • Diagnose bei Verdacht
        • Symptomatik unter Therapie

Zusammenfassung

        • FlowChart

Literatur

 

optionale Diagnostik

PET/CT

        • Unterscheidung SMM-MGUS

low dose CT

        • empfohlen statt SK_Rö
        • Diagnose
        • Responsebeurteilung
        • Symptomatik

 

FISH:

  • Prognosefaktor

  • Der Nachweis von genetischen Aberrationen mittels Floureszenz in situ Hybridisierung ist erforderlich zur Stellung eine Prognose und Unterscheidung low - high risk
  • Empfohlene Untersuchungen:
                • t(4;14)
                • t(14;16); t(14;20)
                • t (11;14)
                • ampl(1q21)
                • del(1p12)
                • del(13q)
                • del17p13)
                • Zytogenetik

 

Veränderungen mit schlechter Prognose:

  • t(4;14) imparts an unfavorable prognosis

        • Fifteen percent of patients exhibit the t(4;14), At least five large studies in over 1500 patients treated with conventional therapy, single or tandem transplant, with or without thalidomide, have demonstrated a uniformly unfavorable prognosis for this group of patients as measured by gene expression, fluorescent in situ hybridization (FISH) or immunohistochemistry
          The t(4;14) population is enriched in IgA isotype MM and in cohorts of patients with relapsed disease .A large percentage (50–80%) of these patients will have a coexistent deletion of chromosome 13 and are frequently hypodiploid (loss of chromosomes) on conventional cytogenetics

  • t(14;16) impart an unfavorable prognosis
  • t(14;20) impart an unfavorable prognosis
  • t(8;20) impart an unfavorable prognosis
        • The t(14;16), t(14;20) and rare t(8;20) are detectable in 6–8% of patients. In at least two series of patient this patient cohort was associated with a shorter survival among patients treated with conventional or tandem transplant-based chemotherapy

  • Deletions of 17p13
        • are detectable in 10% of patients at diagnosis and are associated with a shorter survival after both conventional and high-dose therapy

       

Veränderungen mit guter bzw. neutraler Prognose:

    • t(11;14) by FISH
    • t(6;14) by FISH