Myeloma

Patients with active myeloma have evidence of one or more of the following myeloma defining events referred to as SLiM-CRAB and prompt anti-myeloma treatment is usually required:  

• Myeloma-related end organ damage specifically:
  Calcium elevation in blood (serum calcium > 2.75mmol/L or >0.25mmol/L higher than the upper limit of normal)
  Renal insufficiency (creatinine clearance, <40 ml per min or serum creatinine >177µmol/L)
  Anaemia (haemoglobin <100g/L or >20g/L below lower limit of normal) that cannot be attributed to another cause
  Bone lesions: one or more lytic bone lesion. If bone marrow has <10% clonal plasma cells, more than one bone lesion is required to distinguish from solitary plasmacytoma with minimal marrow involvement.
• And/or one or more of the following:
  – clonal bone marrow plasma cell percentage equal to or greater than 60%
  – involved: uninvolved serum free light chain ratio equal or greater than 100, provided the involved light chain is >100 mg/L
  – More than one focal lesion greater than 5mm in size on MRI. Whole-body MRI is now the gold standard of imaging for newly diagnosed myeloma patients.