The Lancet November 2014: Opdatering af kriterierne for Myelomatose Diagnose

[Carsten Levin]

I the Lancet fra november 2014 har Den Internationale Myelomatose Arbejdsgruppe opdateret kriterierne for diagnostisering af Myelomatose (Multiple Myeloma).

Årsagen til ændringen af definitionen er at man mener at den hidtidige definition medførte for sen aktion for patienter uden de såkaldte CRAB skader. Resultatet af denne senere diagnose er iflg. gruppen øget risiko for de patienter der så ikke får rettidig behandling. CRAB kriterierne (Kalk i blodet, nyreskader, blodmangel og knogleskader) er fortsat væsentlige, men man skal ikke fremover i så høj grad afvente disse skader før man diagnostiserer Myelomatose. I stedet skal skaderne afværges/udsættes ved tidligere behandling – hvis jeg forstår anbefalingen ret.

Med i gruppen bag redefinitionen er bl.a. Hans Erik Johnsen fra Århus Universitet og Angela Dispenzieri fra Mayo Clinic, som bl.a. taler på IMF konferencen i Middelfart d. 7. november. Bare for at nævne nogle få.

This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing requirements of attributable CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). These changes are based on the identification of biomarkers associated with near inevitable development of CRAB features in patients who would otherwise be regarded as having smouldering multiple myeloma. A delay in application of the label of multiple myeloma and postponement of therapy could be detrimental to these patients. In addition to this change, we clarify and update the underlying laboratory and radiographic variables that fulfil the criteria for the presence of myeloma-defining CRAB features, and the histological and monoclonal protein requirements for the disease diagnosis. Finally, we provide specific metrics that new biomarkers should meet for inclusion in the disease definition. The International Myeloma Working Group recommends the implementation of these criteria in routine practice and in future clinical trials, and recommends that future studies analyse any differences in outcome that might occur as a result of the new disease definition.

The Lancet Oncology, Volume 15, Issue 12, Pages e538 – e548, November 2014 <Previous Article|Next Article>
doi:10.1016/S1470-2045(14)70442-5

• Dette emne blev ændret 9 år, 6 måneder siden af Carsten Levin.

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