Quantification of serum M-protein should be performed by densitometry of the monoclonal peak on electrophoresis immunochemical measurement of total immunoglobulin (Ig) isotype level can also be used and is particularly useful for IgA and IgD M-proteins. Immunofixation and serum-free light chain (SFLC) assessment are indicated in patients where there is a strong suspicion of myeloma but in whom routine serum protein electrophoresis is negative ( Pratt, 2008). Electrophoresis of serum and concentrated urine should be performed, followed by immunofixation to confirm and type any M-protein present. Investigation of a patient with suspected myeloma should include the screening tests indicated in Table I, followed by further tests to confirm the diagnosis. 2. Diagnosis, prognostic factors and disease monitoring 2.1 Investigation and diagnosis Spinal cord compression, hypercalcaemia and renal failure are medical emergencies requiring immediate investigation and treatment. Patients with suspected myeloma require urgent specialist referral. Other patients are diagnosed following the incidental detection of a raised erythrocyte sedimentation rate (ESR), plasma viscosity, serum protein or globulin. Recurrent or persistent bacterial infection Presenting clinical features include symptoms of: The majority of cases present de novo but it is now recognized that myeloma is preceded by an asymptomatic monoclonal gammopathy of undetermined significance (MGUS) phase in virtually all patients ( Landgren et al, 2009). Myeloma has a higher incidence in Afro-Caribbean ethnic groups than in Caucasians but there are few other distinctive epidemiological features. The median age at presentation is approximately 70 years. The overall prevalence is likely to be increasing given the recently published data demonstrating improved survival rates over the last decade ( Kumar et al, 2008a Brenner et al, 2009). The annual incidence of myeloma in the UK is approximately 60–70 per million ( ). 1.2 Incidence, prevalence and epidemiology In preparing these guidelines the authors have considered overall cost-effectiveness of recommended interventions as well as clinical efficacy data but formal health economic assessments have not been carried out.
Levels of evidence and grades of recommendation are those of the US Agency for Healthcare Research and Quality (see Appendix I, Tables 1 and 2). Review by a British Society for Haematology (BSH) sounding board. Review by UK Myeloma Forum (UKMF) Executive and British Committee for Standards in Haematology (BCSH) Committees. Involvement of patient advocacy through Myeloma UK. In the absence of randomized data, recommendations were developed on the basis of literature review and a consensus of expert opinion.
Dex online rus roman trial#
Establishment of working groups in the topic areas detailed above followed by review of key literature to 30th June 2010 including Cochrane database, Medline, internet searches and major conference reports.ĭevelopment of key recommendations based on randomized, controlled trial evidence.
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