![]() HSCT ineligible: chemotherapy alone (e.g., dexamethasone and lenalidomide).HSCT eligible: induction chemotherapy followed by autologous HSCT.Eligibility for autologous hematopoietic stem cell transplantation ( HSCT).Risk stratification (e.g., R-ISS stage).Intracytoplasmic crystalline inclusion bodies containing IgG.Clockface nuclei : Chromatin in the periphery of the nucleus resembles a cartwheel or clock face arrangement.Standard risk abnormalities: t(11 14), t(6 14), trisomies.Others: deletion 17p, gain 1q, p53 mutation.High-risk chromosomal abnormalities in multiple myeloma.Fluorescence in situ hybridization ( FISH ): used for staging of multiple myeloma.Indication : : confirmatory test indicated for all patients with suspected multiple myeloma.FDG- PET/CT scan: highest sensitivity for extramedullary disease and active lytic bone lesions.MRI (whole-body or spine and pelvis): highest sensitivity for diffuse bone marrow involvement.Alternative option for baseline and follow-up bone surveillance.Multiple lytic lesions ( "punched-out" holes), e.g., in the skull.May be used to evaluate for skull and rib lesions, which are not well detected by WBLDCT or MRI.Obtain if other more sensitive techniques are not available.Low sensitivity no longer considered the best initial test Bone marrow plasma cell infiltration in long bones.Identification of vertebral instability and fracture risk.Used to guide radiotherapy, biopsies, and surgery.More sensitive than x-rays in detecting focal lesions.First-line test for baseline and follow-up bone surveillance.Imaging studies Whole-body low-dose CT (WBLDCT) Thrombophilia workup (e.g., testing for hereditary thrombophilia or acquired thrombophilias).Diagnostic workup for polyneuropathy (e.g., vitamin B12 levels, nerve conduction studies).Biochemical evaluation for fatigue and unexplained weight loss (e.g., thyroid function test, diabetes mellitus screening).Biochemical evaluation of bone disease (e.g., PTH, vitamin D levels).Bence Jones proteinuria is suggestive of plasma cell disorders (e.g., multiple myeloma, Waldenstrom macroglobulinemia).įurther evaluation for differential diagnoses (guided by clinical features) may include:. ![]() Bence Jones proteins: monoclonal immunoglobulin light chains produced by neoplastic cells. ![]()
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