1 / 25

A Beginner’s guide to Myeloma

A Beginner’s guide to Myeloma. Rod Johnson Leeds Teaching Hospitals. What are Plasma cells?. Differentiated B lymphocytes Antibody producing cells Part of our normal immune response. A Clonal Plasma Cell Disorder depends on the cells and the protein they make. MGUS Myeloma (symptomatic?)

creola
Download Presentation

A Beginner’s guide to Myeloma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A Beginner’s guide to Myeloma Rod Johnson Leeds Teaching Hospitals

  2. What are Plasma cells? • Differentiated B lymphocytes • Antibody producing cells • Part of our normal immune response

  3. A Clonal Plasma Cell Disorderdepends on the cells and the protein they make • MGUS • Myeloma (symptomatic?) • Plasmacytomas • Bony or soft tissue • solitary/multiple • Other paraprotein disorders • Amyloid, neuropathies etc

  4. MGUSMonoclonal Gammopathy of UndeterminedSignificance (!!) • Common, 3-5% of the elderly • Only a third become Myeloma • Some are other diseases (e.g. amyloid) • Can we predict progression? • How often to monitor…..

  5. Epidemiology of Myeloma • 1% of all malignancy (2% Afro-Caribbean) • Annual UK incidence about 6/100,000 • Male:Female ratio is 1.6:1 • Median age at diagnosis is 70 • 10-15% diagnosed <50 yrs • 5% diagnosed <40 yrs

  6. Presenting Features • Bone pain, commonly lumbar spine • Anaemia, often slightly macrocytic • Recurrent infections , mainly chest • Hypercalcaemia • Renal failure • Hyperviscosity (paraprotein) • Amyloid

  7. Diagnosis • Serum and/or urine Paraprotein • Typical bone changes • Marrow excess of plasma cells

  8. Marked Rouleaux formation

  9. Pepper pot skull

  10. Principles of Treatment • Not really a curable disease • Plasmacytomas / ‘operational cures..’ • Treatment dose extend survival • Disease activity correlates with symptoms • Median survival is 48 months

  11. Treatment Options 1.Supportive Care: • Pain control • Radiotherapy or surgery • Control of calcium / Bisphosphonates • Renal support (fluids, ?dialysis) • Blood product support • Management of infection

  12. Treatment options 2.Conventional chemotherapy • Melphalan / Cyclophosphamide • Steroids alone or in addition • Combination Chemo. (ABCM)

  13. Treatment options 3.High dose chemotherapy Infusional chemotherapy High dose melphalan Stem Cell Transplant

  14. Transplant Strategies Autograft Allograft 'Mini' Allograft Total Therapy Double autograft

  15. Newer Agents(if you can afford them…..) • Thalidomide • Other iMIDS (Lenalidomide) • Velcade (Bortezomib) • Future biological agents

  16. Thalidomide • Now established therapy • Has its own particular side effects: • Drowsiness • Constipation • Neuropathy • Thrombosis • Used in various combinations • ?Maintenance therapy…..

  17. Difficult Situations • The elderly patient • The young patient • (The ones in between !!) • The relapsed patient • Renal Failure • Bony/neurological damage • Amyloid

  18. Amyloid • Also responds to Myeloma therapy • Dissolve the protein…………?

  19. Conclusions 1.(The specialist context) • Fascinating new insights into this disease • A wealth of new agents becoming available • Overall survival has improved • Better treatment for older age groups • It costs a lot!

  20. Conclusions 2.(The real context) • Much renewed interest in this disease • A Disease of the elderly • Unpleasant and debilitating • Remains largely incurable • A major problem for continuing care

More Related