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Multiple Myeloma

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Slide 1 :

Multiple Myeloma Clonal malignancy of plasma cells Increasing incidence Blacks:whites 2:1 Age range 20-100 yrs (peak age 70 yrs) Cause unknown Environmental/Genetic factors

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Classical Diagnostic Features of Myeloma Plasmacytosis in marrow Monoclonal protein in serum or urine Lytic disease of bone

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Marrow Plasmacytosis in Myeloma Plasma cells > 10% Usually much higher Often present in ‘sheets’ Alternatively, biopsy-proven plasmacytoma Other causes of plasmacytosis: inflammation, cirrhosis, AIDS

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Diagnosis of Myeloma: Monoclonal Proteins 75-80% have serum monoclonal Ig (M-component, paraprotein, or ‘spike’ on electropheresis) 10-20% make light chains only ? rapid renal excretion ? serum paraprotein absent ? do urine electropheresis Non-secretory myeloma rare (< 1%) Other causes of monoclonal proteins CLL, lymphoma Autoimmune disease, infection Benign monoclonal gammopathy

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Protein Electropheresis (PEP): Apply serum or urine Stain Scan proteins separated according to charge and size

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Patient #1 stain #1 scan Serum Protein Electrophereses in 2 Patients with Myeloma Patient #2 stain #2 scan

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Bone Disease in Myeloma Unbalanced osteoclast activity Radiographic manifestations Osteoporosis almost invariable Usually multiple lytic lesions Axial skeleton involved (active marrow) Osteoblastic reaction minimal Hypercalciuria and hypercalcemia

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Benign Monoclonal Gammopathy Monoclonal Ig as isolated finding More common than myeloma No bone disease, anemia, renal dysfunction Most remain stable About 10% eventually develop classical myeloma

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Clinical Features of Myeloma at Presentation Early - asymptomatic, incidental diagnosis Paraprotein on electropheresis Mild marrow plasmacytosis Solitary plasmacytoma (10% of cases) Late - symptomatic Bone pain (usually lower back) Pneumococcal infection Systemic symptoms (eg, weakness, weight loss) Related to anemia, renal failure, hypercalcemia

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	SlidesOnline 1 Years ago. Category: Research

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