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Multiple myeloma[1]

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Praveen Malik
Praveen Malik

MULTIPLE MYELOMA -HEMATOLOGIC MALIGNANCY-DISEASE OF BONE MARROW - PLASMA CELL DISORDER PATHOLOGY, .CLINICAL FEATURES , AND ITS MANAGMENT REFERENCE HARRISON

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Multiple myeloma[1]
SINGLE MYELOMA
INCIDENCE INCREASES WITH AGE MEDIAN AGE OF DIAGNOSIS 70 YEARS UNCOMMON UNDER 40 YEARS MALES MORE COMMONLY AFFECTED BLACKS HAVE TWICE INCIDENCE THAN WHITES ACCOUNTS FOR 13%OF ALL HEMATOLOGIC CANCER IN WHITE AND 33% IN BLACKS N-RAS, K-RAS AND B-RAF MUTATIONS ARE MOST COMMON AND COMBINED OCCUR IN OVER 40% OF PATIENTS
Multiple myeloma[1]
Multiple myeloma[1]
Proliferation of tumor cells, activation of osteoclasts that destroy bone and suppression of osteoblasts that form new bone
RADIOISOTOPIC BONE SCANNING IS LESS USEFUL IN DIAGNOSIS THAN IS PLAIN RADIOGRAPHY.
Multiple myeloma[1]
Multiple myeloma[1]
Multiple myeloma[1]
OCCURS IN NEARLY 25% OF MYELOMA PATIENTS SOME RENAL PATHOLOGY IS NOTED IN MORE THAN 50% HYPERCALΙEMIA IS THE MOST COMMON CAUSE OF RENAL FAILURE TUBULAR DAMAGE ASSOCIATED WITH THE EXCRETION OF LIGHT CHAINS IS ALMOST ALWAYS PRESENT(ADULT FANCONI SYNDROME) GENERALLY, VERY LITTLE ALBUMIN IS IN THE URINE BECAUSE GLOMERULAR FUNCTION IS USUALLY NORMAL.
DECREASED ANION GAP [I.E., NA+ - (CL- + HC03-) ] BECAUSE THE M COMPONENT IS CATIONIC, RESULTING IN RETENTION OF CHLORIDE RENAL DYSFUNCTION DUE TO LIGHT CHAIN DEPOSITION DISEASE, LIGHT CHAIN CAST NEPHROPATHY AND AMYLOIDOSIS IS PARTIALLY REVERSIBLE WITH EFFECTIVE THERAPY. HYPONATREMIA THAT IS FELT TO BE ARTIFICIAL (PSEUDOHYPONATREMIA) BECAUSE EACH VOLUME OF SERUM HAS LESS WATER AS A RESULT OF THE INCREASED PROTEIN
FANCONI SYNDROME ANAEMIA
NORMOCYTIC NORMOCHROMIC
FAILURE OF ANTIBODY-COATED PLATELETS TO FUNCTION PROPERLY INTERACTION OF THE M COMPONENT WITH CLOTTING FACTORS ANTIBODY TO CLOTTING FACTORS
NEUROLOGICAL SYMPTOMS
Multiple myeloma[1]
•Calcium level increased: serum calcium >0.25mmol/L above the ULN or>2.75mmol/L •Renal insufficiency: creatinine>173mmol/L •Anaemia: hemoglobin 2g/dL below LLN or Hb < 10g/dL •Bony lesion
MGUS Smoldering Myeloma ASYMPTOMATIC MM
Multiple myeloma[1]
Although ~1 % of patients per year with MGUS go on to develop myeloma, all myeloma is preceded by MGUS. MGUS MULTIPLE MYELOMA •Non-IgG subtype， •Abnormal kappa/lambda free light chain ratio •Serum M protein > 15 g/L ( 1.5 g/dL) are associated with higher incidence of progression of MGUS to myeloma. Absence of all three features predicts a 5% chance of progression, whereas higher risk MGUS with the presence of all three features predicts a 60% chance of progression over 20 years
SMOLDERING MM MULTIPLE MYELOMA •Bone marrow plasmacytosis >10% •Abnormal kappa/lambda free light •Chain ratio and serum M protein >30 g/L (3 g/dL) Patients with only one of these three features have a 25% chance of progression to MM in 5 years,whereas patients with high-risk SMM with all three features have a 76% chance of progression
Multiple myeloma[1]
Multiple myeloma[1]
WHAT ABOUT IgM?????
Multiple myeloma[1]
ß2- MICROGLOBULIN
Multiple myeloma[1]
Multiple myeloma[1]
SYNDROME POLYNEUROPATHY ORGANOMRGALY ENDOCRINOPATHY M- PROTEIN SKIN CHANGES
HEAVY CHAINDISEASE FRANKLIN’S DISEASE SELIGMANN’S DISEASE
Multiple myeloma[1]
Multiple myeloma[1]

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Multiple myeloma[1]

  • 3. INCIDENCE INCREASES WITH AGE MEDIAN AGE OF DIAGNOSIS 70 YEARS UNCOMMON UNDER 40 YEARS MALES MORE COMMONLY AFFECTED BLACKS HAVE TWICE INCIDENCE THAN WHITES ACCOUNTS FOR 13%OF ALL HEMATOLOGIC CANCER IN WHITE AND 33% IN BLACKS N-RAS, K-RAS AND B-RAF MUTATIONS ARE MOST COMMON AND COMBINED OCCUR IN OVER 40% OF PATIENTS
  • 6. Proliferation of tumor cells, activation of osteoclasts that destroy bone and suppression of osteoblasts that form new bone
  • 7. RADIOISOTOPIC BONE SCANNING IS LESS USEFUL IN DIAGNOSIS THAN IS PLAIN RADIOGRAPHY.
  • 11. OCCURS IN NEARLY 25% OF MYELOMA PATIENTS SOME RENAL PATHOLOGY IS NOTED IN MORE THAN 50% HYPERCALΙEMIA IS THE MOST COMMON CAUSE OF RENAL FAILURE TUBULAR DAMAGE ASSOCIATED WITH THE EXCRETION OF LIGHT CHAINS IS ALMOST ALWAYS PRESENT(ADULT FANCONI SYNDROME) GENERALLY, VERY LITTLE ALBUMIN IS IN THE URINE BECAUSE GLOMERULAR FUNCTION IS USUALLY NORMAL.
  • 12. DECREASED ANION GAP [I.E., NA+ - (CL- + HC03-) ] BECAUSE THE M COMPONENT IS CATIONIC, RESULTING IN RETENTION OF CHLORIDE RENAL DYSFUNCTION DUE TO LIGHT CHAIN DEPOSITION DISEASE, LIGHT CHAIN CAST NEPHROPATHY AND AMYLOIDOSIS IS PARTIALLY REVERSIBLE WITH EFFECTIVE THERAPY. HYPONATREMIA THAT IS FELT TO BE ARTIFICIAL (PSEUDOHYPONATREMIA) BECAUSE EACH VOLUME OF SERUM HAS LESS WATER AS A RESULT OF THE INCREASED PROTEIN
  • 15. FAILURE OF ANTIBODY-COATED PLATELETS TO FUNCTION PROPERLY INTERACTION OF THE M COMPONENT WITH CLOTTING FACTORS ANTIBODY TO CLOTTING FACTORS
  • 18. •Calcium level increased: serum calcium >0.25mmol/L above the ULN or>2.75mmol/L •Renal insufficiency: creatinine>173mmol/L •Anaemia: hemoglobin 2g/dL below LLN or Hb < 10g/dL •Bony lesion
  • 21. Although ~1 % of patients per year with MGUS go on to develop myeloma, all myeloma is preceded by MGUS. MGUS MULTIPLE MYELOMA •Non-IgG subtype， •Abnormal kappa/lambda free light chain ratio •Serum M protein > 15 g/L ( 1.5 g/dL) are associated with higher incidence of progression of MGUS to myeloma. Absence of all three features predicts a 5% chance of progression, whereas higher risk MGUS with the presence of all three features predicts a 60% chance of progression over 20 years
  • 22. SMOLDERING MM MULTIPLE MYELOMA •Bone marrow plasmacytosis >10% •Abnormal kappa/lambda free light •Chain ratio and serum M protein >30 g/L (3 g/dL) Patients with only one of these three features have a 25% chance of progression to MM in 5 years,whereas patients with high-risk SMM with all three features have a 76% chance of progression