General Internal Medicine

Myeloma

Questions discussed in this category

Should you consider thromboprophylaxis, even for low-dose lenalidomide maintenance, post-autologous transplantation?

How does one interpret an SPEP showing potentially obscured but non-quantifiable M-spike however an IFE showing monoclonal protein?

Can you elaborate on reasons for a non-quantifiable SPEP and how does one follow the paraprotein?

3 Answers available

How do you evaluate a patient with MGUS and peripheral neuropathy?

Can you explain when would you consider light chain amyloidosis work up with fat pad biopsy?

1 Answer available

How do you discuss harms of MGUS screening with other medical providers?

For example, how do you address tendency to "over-order" these tests in patients with common aches/pains but no structural abnormalities on advanced i...

2 Answers available

How extensive of a workup do you do for systemic AL amyloidosis for a patient with a resected amyloidoma, localized AL amyloid deposition in their airway or lungs, who has no other symptoms?

Would you do a 24-hour urine and echocardiogram in all of these patients? Cardiac biomarkers, PT/PTT, or any other such blood tests?

3 Answers available

How would you manage a patient with new renal failure and mild anemia in the setting of a moderate M-Spike and low kappa/lambda ratio, but with negative PET and bone marrow with <10% plasma cells?

1 Answer available

What would be your next step in workup for a patient with IgG Kappa Monoclonal protein detected on SPEP and free lambda light chains found in the urine, with chronic diarrhea for 3 years and concern for GI amyloidosis?

1 Answer available

What is your approach for using anticoagulation/aspirin in patients with multiple myeloma?

2 Answers available

For hypogammaglobulinemia as a complication of successful treatment, do you empirically start prophylaxis with either 400 mg/kg monthly for IVIG or 100 mg/kg weekly for subcutaneous immune globulin?

1 Answer available

How do you approach work-up for a patient suspected for monoclonal gammopathy of renal significance for whom renal biopsy is contraindicated?

E.g. a patient with monoclonal protein with mild light chain ratio elevation. Do we need to get a BM biopsy in all such patients?

2 Answers available

What infectious prophylaxis do you use for patients with newly diagnosed multiple myeloma?

How do you decide how long to continue?

1 Answer available

How does one interpret persistently positive lambda light chains on serum immunofixation but without measurable serum monoclonal protein and a normal light chains and ratio?

Is a repeatedly abnormal serum immunofixation all it takes for MGUS?

2 Answers available

Why are autoantibodies not often detected on monoclonal gammopathy assays (SPEP/IFE, quantitiative immunoglobulins)?

For example, in cold agglutinin disease or AIHA, antibodies can be detected via DAT, but are often not observed on assays for monoclonal gammopathies.

1 Answer available

How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?

2 Answers available