TITULO PRINCIPALMARIA CAMILA RODRIGUEZ

MARIANA PATIÑOTercer Semestre – Medicina

UPB – Medellín2015

INTRODUCTION

• MULTIPLE MYELOMA

Type of cancer caused by the uncontrolled

proliferation of monoclonal plasma

cells

Resulting in the production of monoclonal immunoglobulin (Ig) and

substancial immunosupression and

endorgan damage

INTRODUCTION• MM is characterized by several features, including:

Low blood counts. Bone and calcium problems. Infections. Kidney failure. Monoclonal gammopathy. Light chain amyloidosis. Solitary plasmocytomas.

INTRODUCTION

• COMPLICATIONS OF MM

RENAL DYSFUCTION

EXTRAMEDULLARY PLASMOCYTOMA

(EMP)

INTRODUCTION• HOW IS IT DIAGNOSED?1. Medical history and physical examination

2. LABORATORY TESTS Blood counts Quantitative Igs Electrophoresis (SPEP, IFE, UPEP) Free light chains Beta-2-microglobulin Blood chemistry tests

3. BONE MARROW BIOPSY AND ASPIRATION Immunohistochemistry Flow citometry Cytogenetics FISH

INTRODUCTION

4. BIOPSY TESTS FOR AMYLOID

5. IMAGING TESTS Bone X-rays CAT scans MRI scans Positron emission tomography scans Echocardiogram

6. PROGNOSIS

INTRODUCTION

• LAMBDA CHAINSAmino acid sequenceLight chain of immunoglobulins

Their main fuction is to bind the antigen in the outer part of the arm

that they conform with the heavy chains right in

the variable region

OBJECTIVE

• The objective of the study was to conduct a restrospective analysis of the clinical characteristics of a group of patients with multiple myeloma who had two different immunoglobulin Λ light chains as determined by immunofixation electrophoresis (IFE).

MATERIALES Y METODOS

TRATAMIENTO

Régimen PD ± T (bortezomib y dexametasona con o sin talidomida).Régimen PAD (bortezomib, doxorubicina y dexametasona).Régimen VAD (vindesina, doxorubicina y dexametasona).Régimen de TAD (talidomida, doxorrubicina y dexametasona).Régimen TD ±CTX (talidomida, dexametasona con o sin ciclofosfamida).

ESTRATEGIAS DE TRATAMIENTO

RADIOTERAPIA SCT TD± CTXTADVADPAD PD± T

EMP APTOSSIN

BORTEZOMIBCON

BORTEZOMIB

TRATAMIENTOAdemás de tratamiento antimieloma, todos los pacientes recibieron CUIDADOS DE APOYO INTENSIVO, que incluyen:• Hidratación intravenosa.• Alcalinización de la orina.• La corrección de la hipercalcemia.• Interrupción de todos los agentes nefrotóxicos potenciales.• Diálisis renal a los pacientes con disfunción renal grave.

PRUEBAS Y FUNDAMENTO• IFE: Se utilizó para determinar las cadenas ligeras lambda de las inmunoglobulinas. Este

examen se emplea con mayor frecuencia para verificar los niveles de ciertos anticuerpos asociados con MM y macroglobulinemia de Waldenstrom. Estos anticuerpos abarcan IgG, IgM, IgA, formas de cadena ligera lambda y formas de cadena ligera kappa.

• FISH: Se utilizó para determinar que tenían anomalías t (4; 14), t (14; 16) o anomalías del 17p. Este examen se utiliza para determinar translocaciones de los cromosomas.

RESULTADOS

DISCUSSION

NUMBER OF REFERENCE

AUTHORWHAT HE SAID AGREED OR NOT

8 Yang GZ, et al

With the clinical application of novel

strategies and agents such as autologous

SCT and bortezomib, this situation has

improved (about the renal dysfunction).

9 Dimopoulus MA, et al

The pathophysiology of the most common types of renal injury observed in myeloma is closely linked to the renal handling of light chains.

DISCUSSION

11 Bladé J; at al

In a study by Bladé at al, EMP was

reported in 15-20% of patients at

diagnosis and in an additional 15% of

patients during follow up.

12 Bladé J; at al

Another study described a series of 12 patients with MM aged <40 years

with a high incidence of EMP.

CONCLUTIONS• This study is important to be the base of study in the future of MM

associated to immunoglobulin λ light chains and the next scientists could find the cure of this pathology.

• The study couldn't find the cause of MM associated to immunoglobulin λ light chains but this study could find relation of immunoglobulin λ light chains and renal dysfunction and EMP.

CONCLUTIONS• The change of the structure components of biomolecules like

immunoglobulins can cause severe problems in their function and metabolism, that’s why molecular methods are so important when we are looking for a diagnosis and a treatment for some diseases like multiple myeloma.

CONCLUTIONS• Alternating empirical treatments for different diseases that

don’t have a specific one is beneficial to understand the effects of using certain specific drugs and methods, in order to provide diversity of treatments to achieve the most effective one.

Mapa conceptual: María Camila Rodríguez

Mapa conceptual: Mariana Patiño

BIBLIOGRAPHY• Yang GZ, et al. Clinical characteristics of a gruop of patients with multiple

myeloma who had two different lambda light chains by immunofixation electrophoresis: A retrospective study from a single center. Experimental and therapeutic medicine. 9: 1895-1900, 2015.

• American Cancer Society. Multiple Myeloma. 2014.• Palumbo, Antonio, M.D.; Anderson, Kenneth, M.D. Multiple Myeloma.

NEJM;364: 1046-60. 2011.• Federal University of Agriculture, Abeokuta. Immunoglobulins: types,

functions structure and biomedical importance. • MARTINEZ SÁNCHEZ, Lina María. Biología molecular. 8. ed. Medellín: UPB.

Fac. de Medicina, 2015.