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25.9. Management of multiple myeloma in Asia: resource-stratified guidelines

Chapter 25
Section Contents

In this review, Tan et al. [593] provide guidelines that have been developed specifically for the management of MM in Asia. These recommendations take into consideration differing health care resource and expertise across Asian countries.

Diagnostic work-up

These guidelines state that IFE and sFLC assessment are essential, especially in patients suspected of having myeloma but who have negative SPE results. Where these tests are not routinely available, physicians are advised to consider sending blood specimens to high-level centres for testing if a diagnosis of LCMM, oligosecretory MM or NSMM is suspected.

Disease monitoring

In patients with LCMM, oligosecretory MM or NSMM, sFLC analysis should be used for the assessment of response and subsequent progression. Treatment response should be defined according to the IMWG uniform response criteria (Section 25.3.5). The sCR category may be applicable only in centres where sFLC testing is available, and may be more relevant in a clinical trial setting.

Questions

  1. What algorithm do current guidelines recommend for the screening of suspected monoclonal gammopathies?

Answers

  1. sFLC assays are recommended for use in combination with serum protein electrophoresis (SPE) and serum immunofixation electrophoresis (sIFE). However, if AL amyloidosis is suspected a 24-hour urine should also be requested (Section 25.3.1).
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