Patients received escalating doses of Iberdomide (0.3C1.6 mg on days 1C21 of each 28-day cycle) and oral Fertirelin Acetate dexamethasone (40 mg or 20 mg [if age 75 years]) once a week. outcomes and patient quality of life (QoL). Table 1 Differential Diagnosis of MM
MGUS11C2% of adults older than 50 yearsM protein level< 3g/dl<10% plasma cellsAbsence of myeloma-defining conditions or myeloma-related organ or tissue damageSmoldering (Asymptomatic MM)5 to 7 in 1,000,000M protein level3 g/dl10 to 59% plasma WS 12 cells on bone marrow biopsyAbsence of myeloma-defining conditions or myeloma-related organ or tissue damageDefinition of smoldering multiple myeloma include serum monoclonal protein (IgG or IgA) 3 g/dl or urinary monoclonal protein 500 mg per 24 hours and/or clonal bone marrow plasma cells 10 to 59% with absence of myeloma defining events or amyloidosisSymptomatic MM5 to 7 in 1,000,000M protein level3 g/dl60% plasma cells on bone marrow biopsyPresence of at least one myeloma-defining condition or myeloma-related organ or tissue damageMyeloma-related organ damage includes. Hypercalcemia (Calcium >1 mg/dl upper limit of normal or >11 mg/dl) WS 12 Kidney injury creatinine >2 mg/dl or Creatinine clearance <40 mL/min per 1.73 m2 Anemia hemoglobin < 10 g/dl or >2 g/dl below lower normal limits 1 lytic lesion on imaging studies Myeloma defining condition Plasma cells 60% on bone marrow biopsy Ratio of involved-to-uninvolved serum light chain is 100 or involved protein level 10 mg/dl or higher >1 lytic lesion 5 mm on MRI2 Definition of multiple myeloma include clonal bone marrow plasma cells 10% or biopsy-proven bony or extramedullary plasmacytoma and any one or more of the Myeloma-related organ damageWaldenstr?m macroglobulinemia7 to 10 per 1,000,000IgM paraproteinHypercellular bone marrow with plasma cells, lymphocytes, and lymphoplasmacyticVision changes, Epistaxis, retinal changes, and Neurological changes. Monoclonal gammopathy of an IgM should be present in serum irrespective of size.3 Bone marrow biopsy must demonstrate infiltration 10% by small lymphocytes that show plasmacytoid or plasma cell differentiation with intertrabecular pattern.4 Immunophenotype of infiltrates should be (IgM+, CD5-/+, CD10-, CD11c-, CD19+, CD20+, CD22+, CD23-, CD25+, CD27+, FMC7+, CD103-, CD138-) with plasmacytic component CD138+, CD38+ and CD45- or dim Light-chain (AL) Amyloidosis5 to 13 per 1,000,000Immunoglobulin light chain<10% plasma cells, Congo red staining on bone marrow biopsy or fat pad biopsyPeripheral Neuropathy, Gastrointestinal symptoms, congestive heart failurePlasmacytomaRareN/ATumor positive for plasma cells, but bone marrow is negative for plasma cell neoplasmsDepending on up locationBone pain or compressive symptoms Open in a separate window Abbreviations: MGUS, monoclonal gammopathy of undetermined significance; MRI, Magnetic resonance imaging. MM is the second most common hematologic malignancy, with an estimated incidence of 34,470 adults (19,100 men and 15,370 women) in the US in 2022.5 MM is more common in Black compared to non-Hispanic White individuals and more WS 12 common in men than women. The median age of initial diagnosis is 66 years.6,7 MM evolves from MGUS, a premalignant asymptomatic condition, which occurs in 3% of those over the age of 50.8,9 MGUS progresses to MM or related malignancies, including AL amyloidosis, lymphoma, or WM, at a rate of 1% per year.10 An intermediate, asymptomatic premalignant condition referred to as SMM carries a risk of progressing to MM of 10% per year in the first 5 years from initial diagnosis.10 A recent study of >75,000 individualsthe Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) studyshowed that SMM had a prevalence of 0.5% in individuals over 40 years old, was more common in.