SMM - smoldering multiple myeloma
           asymptomatische Myelom
           Risiko

 

Risikostratifizierung des SMM entweder nach Mayo oder Pethema Kriterien.

Pethema erfordert spezielle FACS Analyse, daher Verwendung von Mayo Kriterien

Konsequenz derzeit - Auswirkung auf Beobachtungsintervall

Therapie von high risk derzeit nur in Studien empfohlen.

 

low risk:

Mayo=1 Faktor

Pethema=0 Faktor

Progression=25%/5Jahre

Beobachtung alle 3-6 Mo



intermediate risk:

Mayo=2 Faktor

Pethema=1 Faktor

Progression=50%/5Jahre

Beobachtung alle 3 Mo

 

high risk:

Mayo=3 Faktor

Pethema=2 Faktor

Progression=70%/5Jahre

Beobachtung alle 1-3 Mo

Therapie in Studien

 

Definition:

Mayo Clinic criteria - 3 Faktoren

  1. Knochenmarkinifiltration >10%
  2. M-protein >3 g/L
  3. FLC ratio <0.125 or >8

1 Faktor = low risk SMM
2 Faktoren = intermediate risk SMM
3 Faktoren = high risk SMM

 

PETHEMA criteria

Voraussetzung FACS Analyse
  1. 95% abnormal plasma cells, including decreased CD38 expression, expression of CD56, and absence of CD19 and/or CD45
  2. Immunoparesis

0 Faktor = low risk SMM
1 Faktoren = intermediate risk SMM
2 Faktoren = high risk SMM

 

Other risk factors

  • IgA isotype
  • the presence of proteinuria
  • circulating plasma cells
  • high proliferative rate of bone marrow plasma cells
  • abnormal MRI findings

 

chromosomal abnormalities critical for the rate of progression

  • deletion 17p
  • t(4;14) is associated with the shortest time to progression
  • trisomies were a risk factor for progression
  • 1q21 were also associated with increased risk for progression
  • evolving nature of the M spike

 

International Myeloma Working Group criteria for SMM:

  • Serumelektrophorese


  • Knochenmarkbiopsie



  • 24h Sammelurin



  • Niere,Elo,Blutbild, Skelett-Rö, MR Wirbelsäule-Becken