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Multiple Myeloma. Matt Elliott. Definition. Neoplastic proliferation of a single clone of plasma cells that produces a monoclonal immunoglobin Proliferation often results in osteolytic lesions, osteopenia, and/or pathologic fractures. Etiology. Not definitively known

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multiple myeloma

Multiple Myeloma

Matt Elliott

definition
Definition
  • Neoplastic proliferation of a single clone of plasma cells that produces a monoclonal immunoglobin
  • Proliferation often results in osteolytic lesions, osteopenia, and/or pathologic fractures
etiology
Etiology
  • Not definitively known
  • Relation to radiation, benzene, organic solvents, herbicides, and insecticides has been proposed
  • Chronic inflammatory diseases
  • Kaposi’s sarcoma (HHV 8)
  • Genetic?
epidemiology
Epidemiology
  • 1% of all malignant disease
  • 10% of hematologic malignancies
  • More frequent in men
  • 2X as common in AA
  • Median: 66 years
manifestations
Manifestations
  • Bone pain (60%)- back or chest
  • Reduction in height
  • Weakness and fatigue (32%)
  • Weight loss (24%)
  • Pallor
  • Radiculopathy- thoracic or lumbosacral area
  • Infection- 45% of deaths w/i 60 days of diagnosis
infection
Infection
  • Impaired lymphocyte function
  • Suppression of plasma cell function with hypogammaglobulinemia
  • Neutropenia and corticosteroid treatment during chemotherapy
organisms
Organisms
  • S. pneumoniae
  • H. influenzae
  • E. coli
bone pain
Bone Pain
  • Radiographic abnormalities in 80%
  • Increased osteoclastic activity and decreased osteoblastic activity through release of cytokines
imaging
Imaging
  • Skeletal survey: punched out lytic lesions, osteopenia, pathologic fractures.
    • Skull, vertebral bodies, thoracic cage, pelvis, proximal humeri and femora
  • MRI/CT: commonly used in patients with no explanation for bone pain after survey
  • Bone scanning: not often used (detects osteoblastic activity)
  • PET scanning: possible in the future
renal disease
Renal Disease
  • Renal failure common, d/t hypercalcemia or cast nephropathy
lab findings
Lab Findings
  • Anemia
  • Rouleaux
  • Plasmacytosis
  • Leukopenia and thrombocytopenia
  • Monoclonal proteins:
    • IgG (52%)
    • IgA (21%)
    • Bence Jones (16%)
    • IgD (2%)
bone marrow biopsy
Bone Marrow Biopsy
  • More than 10% plasma cells
treatment
Treatment
  • Autologous hematopoietic cell transplantation (HCT)
  • Chemotherapy including corticosteroids
  • Local radiation of bone lesions
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