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Multiple Myeloma

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

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  1. Multiple Myeloma Matt Elliott

  2. 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

  3. 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?

  4. Epidemiology • 1% of all malignant disease • 10% of hematologic malignancies • More frequent in men • 2X as common in AA • Median: 66 years

  5. 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

  6. Infection • Impaired lymphocyte function • Suppression of plasma cell function with hypogammaglobulinemia • Neutropenia and corticosteroid treatment during chemotherapy

  7. Organisms • S. pneumoniae • H. influenzae • E. coli

  8. Bone Pain • Radiographic abnormalities in 80% • Increased osteoclastic activity and decreased osteoblastic activity through release of cytokines

  9. 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

  10. Renal Disease • Renal failure common, d/t hypercalcemia or cast nephropathy

  11. Lab Findings • Anemia • Rouleaux • Plasmacytosis • Leukopenia and thrombocytopenia • Monoclonal proteins: • IgG (52%) • IgA (21%) • Bence Jones (16%) • IgD (2%)

  12. Bone Marrow Biopsy • More than 10% plasma cells

  13. Treatment • Autologous hematopoietic cell transplantation (HCT) • Chemotherapy including corticosteroids • Local radiation of bone lesions

  14. QUESTIONS??

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