Multiple myeloma is a malignant disease of plasma cells in the bone marrow. It produces monoclonal proteins (most commonly IgG or IgA) and can cause bone destruction, kidney damage, low blood cell counts, and infections. Diagnosis requires evidence of paraprotein, bone lesions, or plasma cell infiltration of bone marrow. Treatment involves supportive care, chemotherapy, and sometimes stem cell transplantation, though multiple myeloma remains incurable.
Multiple myeloma is a malignant disease of plasma cells in the bone marrow. It produces monoclonal proteins (most commonly IgG or IgA) and can cause bone destruction, kidney damage, low blood cell counts, and infections. Diagnosis requires evidence of paraprotein, bone lesions, or plasma cell infiltration of bone marrow. Treatment involves supportive care, chemotherapy, and sometimes stem cell transplantation, though multiple myeloma remains incurable.
Multiple myeloma is a malignant disease of plasma cells in the bone marrow. It produces monoclonal proteins (most commonly IgG or IgA) and can cause bone destruction, kidney damage, low blood cell counts, and infections. Diagnosis requires evidence of paraprotein, bone lesions, or plasma cell infiltration of bone marrow. Treatment involves supportive care, chemotherapy, and sometimes stem cell transplantation, though multiple myeloma remains incurable.
Amoud university for health and science institute 6/29/2014 Dr mukhtar jama nour,MBBS 1 What is multiple myeloma?
It is a malignant disease of the plasma cells of bone marrow.
Remains an incurable disease. 6/29/2014 Dr mukhtar jama nour,MBBS 2 What is the most common monoclonal protein found in MM? IgG (55%) IgA (20%)
In approximately 20% there is no paraproteinaemia, only light chains in the urine.(Bence jones proteins) 6/29/2014 Dr mukhtar jama nour,MBBS 3 What are the risk factors for MM? Age >60. Exposure to pesticides. Radiation Benzene HSV8 (Kaposis sarcoma Herpes Virus)
6/29/2014 Dr mukhtar jama nour,MBBS 4 What are the clinical features of MM? Disease of elderly. Median age >60 More common in black Africans.
Bone destruction Renal failure Bone marrow infiltration
6/29/2014 Dr mukhtar jama nour,MBBS 5 May be symptomatic or asymptomatic.
Symptomatic myeloma characterized by presence of ROTI and CRAB.
Myeloma Related Organ or Tissue Impairment.
Calcium levels increased Renal failure Anemia Bone lesion
6/29/2014 Dr mukhtar jama nour,MBBS 6 What is the cause for renal failure in MM? Deposition of light chains in the tubules (most common).
Also: hypercalcaemia, hyperuricaemia, use of NSAIDs (rarely) and deposition of amyloid.
6/29/2014 Dr mukhtar jama nour,MBBS 7 What is the consequence of bone marrow infiltration with plasma cells? anaemia neutropenia Thrombocytopenia Production of paraproteins. 6/29/2014 Dr mukhtar jama nour,MBBS 8 What is the consequence of bone destruction in MM? 6/29/2014 Dr mukhtar jama nour,MBBS 9 Fracture of long bones Vertebral collapse Hypercalcemia
6/29/2014 Dr mukhtar jama nour,MBBS 10 In MM which bone activity is increased? Osteoblast or osteoclast? 6/29/2014 Dr mukhtar jama nour,MBBS 11 Increased osteoclastic activity.
That is why biphosphonates is useful in MM because it inhibits osteoclastic activity. 6/29/2014 Dr mukhtar jama nour,MBBS 12 Why do patients with MM get recurrent infections?
6/29/2014 Dr mukhtar jama nour,MBBS 13 Because there is a reduction in the normal immunoglobulin levels (immuneparesis), contributing to the tendency for patients with myeloma to have recurrent infections. 6/29/2014 Dr mukhtar jama nour,MBBS 14 diagnosis What are the imaging studies used to diagnose MM? 6/29/2014 Dr mukhtar jama nour,MBBS 15 Skeletal survey-lytic lesion. easily seen in skull. CT, MRI and PET are used in plasmacytomas (bone or soft tissue deposits). MRI spine- may show imminent compression/collapse.
6/29/2014 Dr mukhtar jama nour,MBBS 16 Thoracic compresion fracture due to MM 6/29/2014 Dr mukhtar jama nour,MBBS 17 Myeloma affecting the skull. Note the rounded lytic translucencies produced by infiltration of the skull with myeloma cells. 6/29/2014 Dr mukhtar jama nour,MBBS 18 FBC- normal or low. ESR, CRP-almost always raised. U&Es, Cr-renal failure Raised LDH Serum calcium- normal or raised. Serum ALP-normal Uric acid-normal or raised Bone marrow aspirate or trephine shows infiltration by plasma cells Amyloid may be found.
6/29/2014 Dr mukhtar jama nour,MBBS 19 Two out of three diagnostic features should be present: paraproteinaemia or Bence Jones protein radiological evidence of lytic bone lesions an increase in bone marrow plasma cells. 6/29/2014 Dr mukhtar jama nour,MBBS 20 What is the treatment for MM? 6/29/2014 Dr mukhtar jama nour,MBBS 21 supportive care chemotherapy Autologous or allogeneic stem cell transplantation. 6/29/2014 Dr mukhtar jama nour,MBBS 22 What is the supportive therapy? 6/29/2014 Dr mukhtar jama nour,MBBS 23 Treat the anemia-erythropoetin helps. Treat the infection Radiotherapy/sytemic chemo/high dose for bone pain. vertebroplasty for treating vertebral fractures. Biphosphonates (pamidronate/zoledronic acid).
6/29/2014 Dr mukhtar jama nour,MBBS 24 For elderly What are the chemo options? If not fit for transplant, treat with Melphalan + Prednisone + Thalidomide (MPT).
6/29/2014 Dr mukhtar jama nour,MBBS 25 For younger patients High-dose dexamethasone based induction.
Followed by high-dose melphalan with peripheral blood stem cell rescue (auto transplantation)
Stem cell transplant- improves survival but not curative. median survival increasing to 6 years. 6/29/2014 Dr mukhtar jama nour,MBBS 26 6/29/2014 Dr mukhtar jama nour,MBBS 27