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GAMMOPATIE MONOCLONALI

GAMMOPATIE MONOCLONALI. ACETATO DI CELLULOSA ROSSO PONCEAU. ACETATO CELLULOSA. AGAROSIO. STABLE. PROGRESSIVE. DIVISIONE UNIVERSITARIA DI EMATOLOGIA AZIENDA OSPEDALIERA SAN GIOVANNI TORINO, ITALY. BENIGN MONOCLONAL GAMMOPATHY. DOES EXIST ?. frequency.

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GAMMOPATIE MONOCLONALI

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  1. GAMMOPATIE MONOCLONALI

  2. ACETATO DI CELLULOSA ROSSO PONCEAU

  3. ACETATO CELLULOSA AGAROSIO

  4. STABLE PROGRESSIVE

  5. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY BENIGN MONOCLONAL GAMMOPATHY DOESEXIST? frequency Percentage of neoplastic transformation M. Boccadoro www.mieloma.it

  6. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY BENIGN MONOCLONAL GAMMOPATHY M-COMPONENT ASYMPTOMATIC NO OSTEOLYTIC LESIONS

  7. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY MONOCLONAL GAMMOPATHIES STABLE MDD PROGRESSIVE NN

  8. Normal plasma cell Monoclonal gammopathy Myeloma Extra- medullary myeloma DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY Multistep cancerogenesis of myeloma Kariotipic instability K, N-ras, P53 mutations Chromosome translocation IgH switch region

  9. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY Incidence of Multiple Myeloma, macroglobulinemia, amyloidosis after recognition of M-component Kyle R.A., Baillieres Clin Hematol, 1995

  10. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY BENIGN MONOCLONAL GAMMOPATHY MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE MGUS

  11. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY FREQUENCY OF MONOCLONAL GAMMOPATHIES Related to the sensitivity of the method

  12. 1-2 % normal population > 10 g/L ~ 10 % normal population < 5 g/L DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY MONOCLONAL GAMMOPATHIES Detected by standard methods Detected by sensitive methods

  13. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY OCCURRENCE OF MONOCLONAL GAMMOPATHIES IN A GENERAL HOSPITAL - Out-patients referred for routine laboratory tests - Ospedale Evangelico Valdese, Torino - Laboratorio analisi (Director: M. Saitta) - routine agarose electrophoresis (Hydrasis Ciampolini) - period: Genuary- May 1998 - 3013 serum samples analysed - 128 monoclonal gammopathies detected (4.2%)

  14. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY FREQUENCY OF MONOCLONAL GAMMOPATHY ACCORDING TO AGE %

  15. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY DISTRIBUTION OF M-COMPONENT CONCENTRATION (g/L) Aguzzi et al, Eur J Haematol, 1992

  16. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY DISTRIBUTION OF M-COMPONENT CONCENTRATION (g/L) Ospedale Evangelico Valdese, Torino

  17. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY MONOCLONAL GAMMOPATHY PROBABILITY OF TRANSFORMATION TO A MALIGNANT DISEASE • Evaluated in patient series: • Diagnosis 1960s - 70s • Standard electrophoresis • M-component at presentation >15 g/L

  18. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY MONOCLONAL GAMMOPATHY PROBABILITY OF TRANSFORMATION FOR PATIENTS WITH M-component > 15 <30 g/L

  19. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY MONOCLONAL GAMMOPATHY Neoplastic transformation is related to the M-component concentration IgG > 50 g/L require chemotherapy IgG > 30 g/L transformation within 1 year (Dimopoulos, 1993) IgG > 15 < 30 g/L 26% transformation after 10 years (Kyle, 1995) IgG<15 g/L 1.3% transformation after 6 years (Baldini, 1996)

  20. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY BENIGN MONOCLONAL GAMMOPATHY A pre-neoplastic disorder? - 5% frequency M-component - incidence of myeloma 2-4/100.000/year 1 out of 1.000-2000 M-component is transformed to myeloma every year

  21. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY MONOCLONAL GAMMOPATHIES TRANSFORMATION TO MYELOMA Related to M-component level

  22. BENIGN MONOCLONAL GAMMOPATHY MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE MULTIPLE MYELOMA DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY ~ 70% < 10 g/L ~ 4-6% 10-20 g/L 30 g/L

  23. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY BENIGN MONOCLONAL GAMMOPATHY DOES EXIST? PROBABLY YES PROSPECTIVE LARGE STUDIES ON PATIENTS WITH SMALL M-COMPONENTS ARE REQUIRED

  24. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY The New England Journal of Medicine

  25. Normal plasma cell Monoclonal gammopathy Myeloma Extra- medullary myeloma DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY Multistep cancerogenesis of myeloma Kariotipic instability K, N-ras, P53 mutations Chromosome translocation IgH switch region

  26. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY TRANSFORMATION FROM TO BENIGN PRE-NEOPLASTIC

  27. DIVISIONE UNIVERSITARIA DI EMATOLOGIAAZIENDA OSPEDALIERA SAN GIOVANNITORINO, ITALY A. Pileri Principal investigators M. Massaia B. Bruno S. Battaglio A. PalumboP. Omedè M.Ladetto Investigators: S. Bringhen, A. Bertola, G. Aitoro, F. Cavallo, P. Falco, L. Giaccone. R. Ghignone, F. Giaretta, F. Morrone, M. Ruggeri ITALIAN MULTIPLE MYELOMA STUDY GROUP

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