Mexican Consensus of Multiple Myeloma

Abstract

To identify this increasingly common pathology, known as multiple myeloma (MM), it is necessary to refer to the specific factors that characterize it; to this end, the classic criteria known as CRAB (hyperkalemia, renal failure, anemia, and lytic lesions) are available, in which renal failure is one of the most frequent complications. Recently, three indisputable biomarkers have been described for the diagnostic support for MM, which are: more than 10% of clonal plasma cells in bone marrow or, a biopsy that corroborates the presence of a plasmacytoma, light chain ratio ≥ 100 mg/dL and more than one focal lesion on magnetic resonance imaging. A differential diagnosis for plasma cell leukemia, solitary bone plasmacytoma, and extramedullary plasmacytoma should always be considered. Being this an incurable disease, a lot of research has been done regarding its therapeutic management, whose main objective is the disappearance of plasma cells and the patient clinical improvement. Melphalan was the first drug that showed a benefit in 1958 and afterward, with the addition of a steroid as a second drug, it was possible to improve response rates. Subsequently, different molecules were studied, forming multiple combinations, and achieving better rates of overall survival and progression-free survival. Years later, with the arrival of proteasome inhibitors such as bortezomib, and immunomodulators such as thalidomide and lenalidomide, an important turnaround in the disease has been seen, as deeper responses, more prolonged remissions, and improvement in the quality of life of patients have been achieved. This consensus has the purpose of integrating a group of Mexican specialists and promoting the updating of this pathology.

Diagnosing and treating young multiple myeloma patients. Experience from a tertiary-care center in Mexico

“…Reduced-intensity allogenic stem cell transplant should be considered in young and fit patients, especially in those with high-risk cytogenetics and good performance status. Nonetheless, to aid personalized decision-making, future cohorts should also address the effects and complications of treating myeloma patients earlier in life who encounter a longer exposure to drugs 26 .…”

Panorama actualizado en mieloma m�ltiple

“…Su espectro clínico abarca desde la presencia asintomática de una proteína monoclonal en suero u orina (componente M), hasta estados de enfermedad con destrucción de tejido sano. Los síntomas pueden ser resultado de la infiltración de las células plasmáticas clonales y de la proteína monoclonal secretada o de la interacción de la célula plasmática con su microambiente 1 .…”