Abstract
We conducted a retrospective review of multiple myeloma (MM), smoldering multiple myeloma (SMM), and monoclonal gammopathy of undetermined significance (MGUS) patients seen at Mayo Clinic to determine whether a bone marrow biopsy (BM) is necessary in all patients diagnosed with a monoclonal protein. A total of 2254 MM, 397 SMM, and 5836 MGUS patients were included in the study. A total of 29 (1.3%) MM patients “without CRAB/FLC” were identified where BM or advanced imaging was critical for diagnosis, 8 (0.3% MM cohort) of whom were diagnosed with MM solely on BM findings (plasma cells > 60%). Without BM or advanced imaging none of these patients would be classified low-risk MGUS. A total of 314 (79%) MGUS-like SMM patients were identified where classification of SMM was based on BM findings. Without BM 97 would be classified as low/low-intermediate-risk MGUS and 151 intermediate or high-risk MGUS; 66 had missing information precluding classification. Only three (<1% SMM cohort) were low-risk MGUS without abnormalities in hemoglobin, calcium, and renal function. In patients presenting with low-risk MGUS and normal hemoglobin, calcium, and renal function, the risk of missing a diagnosis of SMM and MM by omitting BM is <1%. BM should be deferred in these patients in preference to clinical and laboratory monitoring.
Highlights
Multiple myeloma (MM) is a hematological malignancy that results from neoplastic proliferation of plasma cells in the bone marrow (BM)
Progression from monoclonal gammopathy of undetermined significance (MGUS) to MM may include an intermediate stage of disease, smoldering multiple myeloma (SMM), a heterogeneous entity comprising of a Correspondence: Angela Dispenzieri 1Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA 2Department of Hematology, Fiona Stanley Hospital, Perth, WA, Australia Full list of author information is available at the end of the article group of patients that behave biologically like MGUS and another group that eventually develop clinical manifestations of myeloma requiring therapy such as hypercalcemia, renal dysfunction, anemia and bone lesions (CRAB)3
Assessment of the BM plays a key role in differentiating patients presenting with MGUS from SMM and MM and for prognostication in all groups5–8
Summary
Multiple myeloma (MM) is a hematological malignancy that results from neoplastic proliferation of plasma cells in the bone marrow (BM). In 2018, ~30,770 people will be diagnosed with MM in the United States, accounting for 1.8% of all new cancer cases, and ~12,770 people will die from MM1. MM evolves from the premalignant state of monoclonal gammopathy of undetermined significance (MGUS). Progression from MGUS to MM may include an intermediate stage of disease, smoldering multiple myeloma (SMM), a heterogeneous entity comprising of a. Patients with MGUS or SMM are “asymptomatic,” but in reality many have symptoms that. Sidiqi et al Blood Cancer Journal (2020)10:52 prompted the testing, but these symptoms are eventually deemed not to be related to their plasma cell disorder. We report on patients with SMM and MM that present without symptoms and in whom BM was critical for diagnosis
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