From the Guidelines
M-spike is a critical marker for diagnosing and monitoring multiple myeloma and related plasma cell disorders, and its management depends on the underlying diagnosis, with treatment typically involving combinations of proteasome inhibitors, immunomodulatory drugs, monoclonal antibodies, and steroids for multiple myeloma, and regular monitoring for monoclonal gammopathy of undetermined significance (MGUS) 1.
Key Considerations
- M-spike detection requires further evaluation, including bone marrow biopsy, complete blood count, calcium levels, kidney function tests, and skeletal imaging to determine the underlying condition.
- The size of the M-spike correlates with tumor burden, making it a valuable tool for clinicians managing these conditions.
- For multiple myeloma, treatment typically involves combinations of proteasome inhibitors (bortezomib, carfilzomib), immunomodulatory drugs (lenalidomide, pomalidomide), monoclonal antibodies (daratumumab), and steroids (dexamethasone) 1.
- For MGUS, regular monitoring every 6-12 months is recommended without immediate treatment 1.
Monitoring and Response Assessment
- The M-spike measurement serves as an important marker to monitor disease progression and response to therapy, with decreasing levels generally indicating treatment effectiveness.
- The International Myeloma Working Group (IMWG) criteria provide a framework for response assessment, including complete response, very good partial response, partial response, and progressive disease 1.
Recent Guidelines and Recommendations
- The 2019 ASCO and CCO joint clinical practice guideline recommends treatment of multiple myeloma based on the IMWG criteria, with a focus on individualized care and consideration of patient-related factors, such as age, performance status, and comorbidities 1.
- The guideline also emphasizes the importance of regular monitoring and response assessment to guide treatment decisions and optimize patient outcomes.
From the Research
Definition and Classification of Hypertensive Crises
- A hypertensive crisis is defined as a systolic blood pressure >180 mm Hg or a diastolic blood pressure >120 mm Hg 2, 3.
- Hypertensive crises can be classified as either hypertensive emergencies or urgencies, depending on the degree of blood pressure elevation and presence of end-organ damage 2, 3, 4, 5.
Treatment of Hypertensive Emergencies
- Hypertensive emergencies require immediate reduction of blood pressure with a short-acting, titratable intravenous antihypertensive medication 2, 3, 5, 6.
- Patients with hypertensive emergencies should be treated in an intensive care unit (ICU) 2, 3, 5.
- Rapid-acting intravenous antihypertensive agents, such as labetalol, esmolol, fenoldopam, nicardipine, and clevidipine, are commonly used 2, 3, 4, 5.
Treatment of Hypertensive Urgencies
- Hypertensive urgencies can be treated with oral antihypertensive agents as an outpatient 2, 3, 4, 5.
- The goal is to control blood pressure within 24 hours to several days 4, 5.