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Multiple Myeloma Lymphomas

Multiple Myeloma Lymphomas. Ass. Sklyannaya E.V. Multiple myeloma. Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone. Epidemiology. 4 per 100,000 increased incidence with age. Etiology. radiation chromosomal alterations petroleum products

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Multiple Myeloma Lymphomas

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  1. Multiple MyelomaLymphomas Ass. Sklyannaya E.V.

  2. Multiple myeloma Multiple myeloma represents a malignant proliferation of plasma cells derived from a single clone.

  3. Epidemiology 4 per 100,000 increased incidence with age

  4. Etiology • radiation • chromosomal alterations • petroleum products • Interleukin 6

  5. Pathogenesis leukopenia, anemia, thrombocytopenia interference with the normal production of blood cells lytic lesions in the skeleton Activation of osteoclaststimulating factor bone pain, hypercalcemia, spinal cord compression

  6. Pathogenesis aberrant antibodies impaired humoral immunity high prevalence of infection hyperviscosity, amyloidosis, renal failure

  7. Histologic Findings plasma cells proliferation in the bone marrow

  8. Classification(myeloma staging system)

  9. Clinical Manifestations • bone pain • bony lysis • susceptibility to bacterial infections • renal failure • anemia • clotting abnormalities • neurologic symptoms

  10. Workup • Lab Studies: CBC (anemia, leukopenia, thrombocytopenia, increased ESR), chemistry (hyperproteinemia, disproteinemia, hypercalciemia), urinalysis (proteinuria) • Imaging Studies: skeletal series (bone lesions, impending fractures, cord or root compression) • Bone marrow aspirate: plasma cells infiltration • Electrophoresis and immunofixation of serum and urine: identifying of M component

  11. X-ray of skull

  12. Electrophoresis of serum Norma Monoclonal gammapathy

  13. Diagnosis The classic triad of myeloma: • marrow plasmacytosis (>10%), • lytic bone lesions, • serum and/or urine M component.

  14. Treatment • MP (melphalan and prednisone) • VBMCP (vincristine, bischloroethylnitrosourea, melphalan, cyclophosphamide, and prednisone) • VAD (vincristine, doxorubicin, and dexamethasone) • Thalidomide • Bortezomib • Interferon alfa • Bisphosphonates

  15. Prognosis

  16. Hodgkin Disease Hodgkin disease (HD) is a potentially curable malignant lymphoma with distinct histology, biologic behavior, and clinical characteristics.

  17. Epidemiology • 1.8 cases per 100,000 population in males • 0.8 cases per 100,000 population in females • Age-specific incidence rates have a bimodal distribution in both sexes, peaking in young adults (aged 15-34 y) and older individuals (>55 y)

  18. Pathogenesis clonal proliferation of B lymphocytes from the germinal centers of lymph nodes

  19. Histologic Findings • 1. Nodular sclerosis Hodgkin disease - 60-80% of all cases • 2. Mixed-cellularity Hodgkin disease - 15-30% • 3. Lymphocyte-depleted Hodgkin disease - Less than 1% • 4. Nodular lymphocyte-predominant Hodgkin disease - 5%

  20. Ann Arbor classification (1971) • Stage I denotes a single lymph node area or single extranodal site. • Stage II denotes 2 or more lymph node areas on the same side of the diaphragm. • Stage III denotes lymph node areas on both sides of the diaphragm. • Stage IV denotes disseminated or multiple involvement of extranodal organs. Involvement of the liver or the bone marrow is considered stage IV disease. For staging classifications, the spleen is considered a lymph node area.

  21. Clinical Manifestations • Lymphadenopathy • Splenomegaly/hepatomegaly • Superior vena cava syndrome

  22. Workup • Lab Studies: CBC (elevated ESR, anemia, lymphopenia, neutrophilia, or eosinophilia), lymph node biopsy, bone marrow biopsy. • Imaging Studies: CT scans of the chest, abdomen, and pelvis.

  23. Lymph node biopsy (mixed cellularityHodgkin’s disease)

  24. CT scan

  25. Diagnosis of Hodgkin’s disease is established by review of an adequate biopsy specimen by an expert hematopathologist

  26. Treatment • Radiation therapy • Chemotherapy • Surgery

  27. Chemotherapy • ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) • BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone)

  28. Prognosis HD is a potentially curable neoplasm

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