2. MM
• Cancer of plasma cells
• Malignant B cell lymphoproliferative disorder of the marrow with
plasma cell predominating.
• Most common primary malignancy of the bone.
• Plasma cells comes from B lymphocytes and produce
antibodies(immunoglobulins)
3. MM
• Myeloma cells produce abnormal immunoglobulin.
Overproduction of monoclonal protein or paraprotein
Ineffective immunoglobulin
Leads to decreased bone marrow function
Destruction of bone tissue
4. MM
INCIDENCE
• Increase with age(5th -7th decade)
• Males>females(2:1)
• >40 yrs with new bone tumor should include in d/d of MM and
metastatic carcinoma.
• 1% of all malignancies and 13% of all hematologic cancers( whites)
5. RISK FACTORS
• Age >60
• Exposure to pesticides(DDT)
• Wood, leather,sheet metal and nuclear industry worker
• Petroleum (benzene0
• Kaposi sarcoma Herpes Virus (presence of IL-6 and HHV8)
6. MM: Pathophysiology
The pathological and clinical features of myeloma are due to :
1. Tissue infiltration
2. Production of large amount of paraprotein
3. Impairment of immunity
Plasma cells produce proteins (Antibodies).Antibodies attach to
foreign substances to fight infections and disease.
In MM, the body makes too many Plasma cells. These cells produce
antibodies that the body does not need.
7. Common sites for Bone involvement.
• Skull
• Spine(thoracis,Lumbar,Vertbrae0
• Pelvis
• Long bones
• Spinal cord
8. Clinical Manifestations of MM
• Bone pain ( lower back, long bones or ribs)
• G malaise, Weight loss
• Anaemia,thrombocytopenia..Bleeding
• Renal failure(light chains and amyloid deposition)
• Hypercalcemia (Nausea, fatigues,thirst )
• Hyperviscosity (headaches, bruising, ischemic neurologic symptoms0
• Hyperuricemia
• Infections
• Meningitis
10. DIAGNOSIS OF MM
• Symptomatic myeloma characterized by presence of ROTI and CRAB.
• ROTI > Myeloma Related Organ or Tissue Impairment
• CRAB
Calcium levels increased
Renal failure
Anemia
Bone lesion
11. Dx of MM
FBC – Normal or low
ESR,CRP- Eleveted
Blood films- Rouleaux formation,Mcarocytosis, MCells
Urea,Creatinine- Renal failure
Serum B2 microglobulin>2.5mg/L
Raised LDH
Serum Calcium- N or raised
S ALP-N
Total Protein-N
S Albumin –N or L
12. UA- N or H
BMA Or trephine – infiltration by plasma cells. Amyloid also may be
found
24hrs urine electrophoresis and immunofixation- light chain
excretion
SPE- monoclonal band
Xrayz
Immunohistochemistry
Monoclonal gammopathy
13. • Major diagnostic criteria (Triad of Myeloma)
Plasmacytoma- Biopsy
30% Plasma cells- BMA
Eleveted monoclonal immunoglobulin levels in blood or urine