Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
New diagnosis of multiple myeloma (MM) OR follow-up for established MM
(Specify) Symptoms are variable and may be absent in early stages. Common presenting complaints include:
Bone pain (especially back pain)
Fatigue
Frequent infections
Anemia (pale skin, easy bruising, shortness of breath)
Hypercalcemia (elevated blood calcium) – nausea, constipation, confusion
Kidney problems (protein in urine, decreased urine output)
History of Present Illness:
Onset, duration, and severity of symptoms.
For established MM:
Date of diagnosis and prior treatment history.
Response to previous treatment (improvement or progression of symptoms).
Any new or worsening symptoms.
Past Medical History:
Underlying medical conditions (e.g., kidney disease) that may influence treatment decisions.
History of bone fractures (may be related to MM).
Prior treatments for MM or related conditions (e.g., monoclonal gammopathy of undetermined significance (MGUS)).
Family History:
Family history of blood cancers (not a strong risk factor for MM).
Medications:
List all current medications, including medications for bone pain, anemia, and any current MM therapy.
Social History:
Tobacco use (may increase risk of MM).
Occupational exposures (rarely, exposure to certain chemicals may be a risk factor).
Physical Exam:
General examination: Assess for signs of anemia (pale skin), fatigue, and bone tenderness.
Skeletal exam: Assess for bone pain or tenderness.
Laboratory Tests:
Serum protein electrophoresis (SPEP) and serum free light chain assay (SFLC): Demonstrate an M-protein (monoclonal protein) in the blood or urine, a hallmark finding in MM.
Quantitative immunoglobulins: Measure the levels of different types of immunoglobulins (IgG, IgA, IgM).
Serum calcium: Elevated levels suggestive of hypercalcemia.
Beta-2 microglobulin: Elevated levels correlate with poor prognosis.
Complete blood count (CBC): May reveal anemia (low red blood cell count).
Kidney function tests: Assess for kidney function which can be affected by MM.
Imaging Studies:
Skeletal survey (X-rays): May show bone lesions (lytic or punched-out lesions) characteristic of MM.
Low-dose CT scan: May be used to assess for bone involvement and guide treatment decisions.
PET scan (positron emission tomography): May be used to assess for disease activity and identify areas of increased metabolic activity suggestive of MM involvement.
Bone Marrow Examination:
Bone marrow biopsy and aspirate: Essential for definitive diagnosis of MM. Examines the bone marrow for the presence of abnormal plasma cells.
Cytogenetic testing and FISH (fluorescence in situ hybridization): Performed on bone marrow samples to identify genetic abnormalities in plasma cells, which can influence prognosis and treatment decisions.
Assessment:
Multiple myeloma: Based on clinical presentation (bone pain, fatigue, anemia), laboratory findings (M-protein on SPEP, abnormal bone marrow), and supportive imaging studies (bone lesions on X-rays or CT scan).
Disease stage: Staging systems (e.g., Durie-Salmon or International Staging System (ISS)) classify MM based on factors like bone marrow involvement, serum protein levels, and kidney function. Stage influences treatment decisions and prognosis.
Differential Diagnoses:
Consider other conditions that can cause similar symptoms:
Metastatic bone disease from other cancers
Osteoporosis (bone loss)
Monoclonal gammopathy of undetermined significance (MGUS)
Plan:
Treatment: The goal of treatment is to control disease progression, manage symptoms, and improve survival. Treatment options vary depending on age, overall health, disease stage, and genetic abnormalities. Some common treatment approaches include:
Induction therapy: Aims to destroy cancer cells and reduce M-protein levels. May involve proteasome inhibitors, immunomodulatory drugs (IMiDs), alkylating agents, or corticosteroids.
Autologous stem cell transplantation (ASCT): High-dose chemotherapy followed by reinfusion of the patient