Multiple myeloma
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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