Name

Plasma cell myeloma

ICD-O-1 Morphology

Effective 1978 - 1991

ICD-O-2 Morphology

Effective 1992 - 2000

ICD-O-3 Morphology

Effective 2001 and later

Reportable

for cases diagnosed 1978 and later

Primary Site(s)

C421
Primary site must be bone marrow (C421)

Abstractor Notes

Plasma cell myeloma (PCM) usually has generalized bone marrow involvement. Lytic bone lesions and bone tumor masses of plasma cells also occur.

Approximately 30% of patients with solitary plasmacytoma (bone or outside of bone) defined only by radiographical skeletal survey have additional lesions identified on MRI or CT. These patients are considered to have plasma cell myeloma.

The International Staging System for Multiple Myeloma Staging for Multiple Myeloma is based on:
1. Amount of monoclonal (or myeloma) protein (M protein) in the serum and/or urine
2. Various clinical parameters such as: hemoglobin and serum calcium concentrations, number of lytic bone lesions
3. Presence or absence of renal failure.
Stage I
Stage II
Stage III

Treatment
Watchful waiting: Asymptomatic patients with no lytic lesions and normal renal function.

For patients with symptoms and advanced disease
1. Induction therapy
2. Consolidation therapy
3. Maintenance therapy
4. Supportive care

The presence of plasmacytomas after a diagnosis of plasma cell myeloma indicates an advanced stage of plasma cell myeloma. Do not abstract a new primary for the plasmacytoma(s) (9731/3 or 9734/3) after a diagnosis of plasma cell myeloma.

Diagnostic Confirmation

This histology can be determined by positive histology (including peripheral blood) with or without genetics and/or immunophenotyping. Review the Definitive Diagnostic Methods, Immunophenotyping and Genetics Data sections below, and the instructions in the Hematopoietic Manual for further guidance on assigning Diagnostic confirmation.

Grade

Not Applicable

Module Rule

None

Alternate Names

Alpha PCM
Double-hit multiple myeloma
Early multiple myeloma
Early myeloma
Evolving multiple myeloma
Evolving myeloma
Gamma PCM
High-risk multiple myeloma
Indolent myeloma
Indolent PCM
Kahler's disease
Medullary plasmacytoma
Multiple myeloma
Multiple plasmacytomas (occurring in bone or outside of bone)
Myeloma, NOS
Myelomatosis
Non-secretory myeloma
PCL
PCM
Plasma cell leukemia
Plasmacytic leukemia
Primary PCL
Smoldering myeloma
Triple-hit multiple myeloma

Definition

Plasma cell myeloma (PCM) is a bone marrow-based, multifocal neoplastic proliferation of plasma cells, usually associated with an M protein in serum and/or urine and evidence of organ damage related the plasma cell neoplasm.

Bone marrow is the site of origin of nearly all PCMs, and in most cases there is disseminated bone marrow involvement. Other organs may be secondarily involved. The disease spans a clinical spectrum from asymptomatic to highly aggressive. Diagnosis is based on a combination of clinical, morphological, immunological, and radiological features.

There are three clinical variants of plasma cell myeloma, all of which are coded to 9732/3.

1. Smoldering (asymptomatic) PCM: Bone marrow involvement, but no related organ or tissue impairment. Similar to MGUS in its lack of symptoms, but more likely to develop to symptomatic PCM. About 8% of patients are initially asymptomatic.

2. Non-secretory myeloma occurs when there is absence of an M protein on immunofixation electrophoresis; there is impaired (or not) secretion of immunoglobulin into the blood or urine. A bout 3% of PCM cases are non-secretory.

3. Plasma cell leukemia (PCL) occurs when the number of plasma cells in the peripheral blood is 20% of the leukocyte differential count. Other areas of involvement include spleen, liver, pleural effusions, ascites, and cerebrospinal fluid. PCL may be present at diagnosis or occur as a late feature of PCM (secondary PCL); 2-5% of myeloma cases are primary PCL. Clinical features overall are similar to PCM. Lymphadenopathy, organomegaly and renal failure are often present in PCL. PCL is an aggressive disease with short survival.

4. High-risk multiple myeloma: Having at least one of the mutations related with poor prognosis including; t(4;14) t(14;16), t(14;20), del 17p, p53 mutation, gain 1q and del 1p.

5. Double-hit multiple myeloma: Having at least two of the mutations related with poor prognosis including; t(4;14) t(14;16), t(14;20), del 17p, p53 mutation, gain 1q and del 1p.

6. Triple-hit multiple myeloma: Having at least three of the mutations related with poor prognosis including; t(4;14) t(14;16), t(14;20), del 17p, p53 mutation, gain 1q and del 1p.

Definitive Diagnostic Methods

Bence-Jones protein
Bone marrow biopsy
FISH
Genetic testing
Immunophenotyping
Peripheral blood smear
Serum Protein Electrophoresis (SPEP)

Genetics Data

Five major oncogenes involved in 14q32 translocation: cyclin D1, C-MAF, FGFR3/MMSET, cyclin D3, and MAFB
High load of IGHV gene somatic hypermutation
Immunoglobulin heavy and light chain genes are clonally rearranged
Trisomies
Whole or partial chromosome deletions or translocations

Immunophenotyping

CD19- (no expression/negative)
CD38
CD56 + (aberrant expression/positive) (except PCL)
CD56- (no expression/negative) (PCL)
CD79a
CD138
VS38c

Treatments

Chemotherapy
Hematologic Transplant and/or Endocrine Procedures
Hormone therapy
Immunotherapy

Transformations to

None

Corresponding ICD-9 Codes

203.0 Multiple myeloma

Corresponding ICD-10 Codes

C90.0 Multiple myeloma

Corresponding ICD-10-CM Codes (U.S. only)

C90.0 Multiple Myeloma (effective October 01, 2015)

Signs and Symptoms

Anemia
Bence-Jones protein accumulation in the renal tubules causing renal damage
Bone pain
End-organ damage
Hypercalcemia
Pathological fractures
Skeletal destruction with osteolytic lesions

Diagnostic Exams

Blood and urine immunoglobulin studies
Blood chemistry studies
Cytogenetic analysis
Skeletal survey
Twenty-four-hour urine test

Progression and Transformation

Extramedullary involvement usually indicates advanced disease

Epidemiology and Mortality

Age: 70 years median age (rare in children and adults less than 30)
Incidence: 10-15% of hematopoietic malignancies
Mortality: 20% of deaths from hematopoietic malignancies
Race: Occurs in african americans twice as much as caucasians
Sex: male predominance
Survival: Stage I: 62 months median survival; Stage II: 44 months median survival; Stage III: 29 months median survival

Sources

Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J (Eds):
WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (Revised 4th edition)
IARC: Lyon 2017
Section: Mature B-cell neoplasms
Pages: 243-250

International Classification of Diseases for Oncology, Third Edition, Second Revision. Geneva: World Health Organization, 2020.
Section: ICD-O-3.2 (2020) Morphological Codes
Pages: http://www.iacr.com.fr/index.php?option=com_content&view=category&layout=blog&id=100&Itemid=577

National Cancer Institute
Section: General Information About Plasma Cell Neoplasms
Pages: https://www.cancer.gov/types/myeloma/hp/myeloma-treatment-pdq
Glossary