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Tumor Tip of the Week-Myeloma SSDI’s

Scenario:  11/1/2019 Bone Marrow Biopsy: Hypercellular marrow (60-70%) w/ mature trilineage hematopoiesis. 10% clonal plasma cells identified. See Note:

Serum protein electrophoresis with immunofixation showed a monoclonal IgG lambda. The serum calcium is increased (9.9 mg/dl, < 11mg/dl, does not fulfill WHO definition of organ damage), however, immunostain performed on specimens A and B show ~10% plasma cells and flow cytometry show a clonal plasma cell population. Those findings are a borderline smoldering plasma cell myeloma. Clinical correlation is recommended.

Bone Marrow for Karyotype/FISH analysis (Cytogenetics): Negative for high risk cytogenetics.

11/15/19 Oncology Note Assessment/Plan: IgG Lambda Smoldering Myeloma. Low risk based on MAYO criteria. Recommend observation.


Question:  How would the Schema Discriminator 1 be assigned?

  • 0 Multiple myeloma, Myeloma, NOS, Non-secretory myeloma, Plasma cell lymphoma, Ultra-High Risk Smoldering MM
  • 1 Smoldering plasma cell myeloma (SPCM), Asymptomatic plasma cell myeloma, Early myeloma
    Evolving myeloma
  • 2 Other terminology describing myeloma, Unknown terminology used

Answer:  1 Smoldering plasma cell myeloma

Question:  How would the SSDI High Risk Cytogenetics be coded?

    • 0 High-risk cytogenetics not identified/not present
    • 1 High-risk cytogenetics present
    • 7 Test ordered, results not in chart
    • 9 Not documented in medical record, High Risk Cytogenetics not assessed or unknown if assessed
    • Leave BLANK

Answer:  Leave BLANK

Rationale: Read the notes in the SSDI manual. Note 5: If Schema Discriminator 1: Plasma Cell Myeloma Terminology is coded to 1 or 9, leave this SSDI blank.  *This note also appears in SSDI’s Serum Albumin Pretreatment Level, Serum Beta-2 Microglobulin Pretreatment Level, LDH (Lactate Dehydrogenase) Pretreatment Level

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