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plasma cell neoplasm (single lesion【126陳嘉歡】 (Monoclonal Gammopathy of…

- - - - serum monoclonal protein (M protein) at a concentration <3 g/dL
      - bone marrow with <10 percent monoclonal plasma cells
      - absence of end-organ damage
      - M protein: IgG > IgM > IgA > others
      - 3% 有biclonal gammopathy
    - - 全套血液檢查
      - serum protein electrophoresis and immunofixation
      - Quantitation of immunoglobulins
    - - no treatment needed but monitoring based on the alogrithm
        
        Link Title
  - - - bone lesion biopsy
        
        去看有沒有clonal
      - CT or MRI
        
        no other lytic lesion
        
        只有lesion 是lytic
      - 全套血液檢查
        
        no anemia
        
        no hypercalcemia
        
        no renal insufficiency
      - lesion以外的骨頭biopsy 沒有clonal plasma cell
    - - local RT
        
        有M protein prognosis 好
        
        RT之後 M protein應該會慢慢消失
    - - solitary
      - 發生在骨頭的lesion的部位和MM一樣
      - absence of MM's symptoms 例如anemia, hypercalcemia
      - single clone of plasma cell
      - 男:女=2:1
      - 好發中位數=55-65歲
      - 無end organ damage
  - - - Serum monoclonal (M) protein ≥3 g/dL
        or
        10 to 60 percent bone marrow clonal plasma cells.
      - Absence of lytic lesions, anemia, hypercalcemia, and renal insufficiency
    - - 和以上的一樣
    - - Link Title
- - - - non-secretory myeloma
        
        pattern
        
        :red_cross: monoclonal gammanopathy
        
        immunoglobulin detectable in the plasma cells 85% yes 15% no
        
        Normal serum and urine immunofixation
        
        Normal serum FLC ratio
        
        monitored
        
        bone marrow evaluation
        
        imaging tests
        
        prognosis
        
        比secretory myeloma 稍好
      - classic multiple myeloma
        
        treatment
        
        Link Title
        
        order
        
        全套血液检查
        
        serum protein electrophoresis (SPEP) + immunofixation
        
        M protein： single narrow peak
        
        少数时biclonal gammopathy
        
        serum free light chain (FLC) analysis
        
        hemoglobin ≤12 g/dL
        
        Macrocytosis anemia
        
        normocytic, normochromic anemia
        
        serum creatinine ↑
        
        high FLC levels
        
        light chain cast nephropathy=myeloma kidney
        
        hypercalcemia.
        
        24hr-urine
        
        urine protein electrophoresis (UPEP)
        
        urine protein immunofixation
        
        PET/CT
        
        Extramedullary plasmacytomas (EP)
        
        osteolytic lesions, and/or pathologic fractures
        
        bone scan
        
        osteopenia
        
        renal biopsy
        
        pattern
        
        Bone pain
        
        central skeleton (back, neck, shoulders, pelvis, hip)
        
        induced by movement
        
        less common at night
        
        :check: monoclonal gammanopathy
        
        total serum protein concentration ↑ and/or
        presence of a monoclonal protein in the urine or serum
        
        unexplained anemia
        
        fatigue and pallor
        
        Hypercalcemia
        
        Weight loss
        
        变矮
        
        Extradural spinal cord compression
        
        weakness or paresthesias of the lower extremities, or bladder or bowel dysfunction or incontinence
        
        CY/MRI
        
        neurosurgery
        
        severe back pain
        
        Hyperviscosity
        
        oronasal bleeding, blurred vision, neurologic symptoms, confusion, and/or heart failure
        
        Therapeutic plasma exchange
        
        Infection
        
        Elevated creatinine
        
        renal failure
    - - pattern
        
        Serum protein 正常
        
        serum FLC /UPEP+immunofixation 異常
        
        Ig heavy chain 低
      - complication
        
        light chain cast nephropathy=myeloma kidney
    - - pattern
        
        Serum M protein <1 g/dL
        
        Urine M protein <200 mg/24 hours
      - order
        
        少用SPEP and UPEP（可能是測量誤差）
        
        *Abnormal FLC ratio
        
        (FLC normal/ minimally elevated (<10 mg/dL)
        
        imaging
        
        bone marrow studies