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MULTIPLE MYELOMA(MM)
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)
MM
• Myeloma cells produce abnormal immunoglobulin.
Overproduction of monoclonal protein or paraprotein
Ineffective immunoglobulin
Leads to decreased bone marrow function
Destruction of bone tissue
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)
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)
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.
Common sites for Bone involvement.
• Skull
• Spine(thoracis,Lumbar,Vertbrae0
• Pelvis
• Long bones
• Spinal cord
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
Mechanism of disease
Plasma cell proliferation->anemia, BM suppression, infection risk
Osteoclasts ->bony lesions, fractures, vertebral collapse, spinal cord
compression
Paraprotein, hypercalcemia->renal failure
Hypercalcemia-> polyuria, thirst, drowsiness,coma
May be symptomatic or asymptomatic
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
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
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
• Major diagnostic criteria (Triad of Myeloma)
Plasmacytoma- Biopsy
30% Plasma cells- BMA
Eleveted monoclonal immunoglobulin levels in blood or urine
MYELOMA CYTOGENETICS
del (13)
t(4;14)

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MULTIPLE_MYELOMAMM_2020.pptx

  • 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
  • 9. Mechanism of disease Plasma cell proliferation->anemia, BM suppression, infection risk Osteoclasts ->bony lesions, fractures, vertebral collapse, spinal cord compression Paraprotein, hypercalcemia->renal failure Hypercalcemia-> polyuria, thirst, drowsiness,coma May be symptomatic or asymptomatic
  • 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