jesse c james md am report may 7, 2010. proliferation of malignant plasma cells and a subsequent...
DESCRIPTION
MM accounts for 1% of all American cancers. More frequent in men than women. AfA>WA>AsA Median age 66 ◦ Anemia 73% (normochromic normocytic) ◦ Bone Pain 58% (typically chest/back) ◦ Elevated Creatinine 48% ◦ Fatigue/Malaise 32% ◦ Hypercalcemia 28%TRANSCRIPT
Jesse C James MDAM Report May 7, 2010
Proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein
Malignant plasma cells are responsible for clinical manifestations
Part of a spectrum of diseases ranging from monoclonal gammopathy of unknown significance to plasma cell leukemia
Presentations range from asymptomatic to severe complications
MM accounts for 1% of all American cancers. More frequent in men than women. AfA>WA>AsA
Median age 66◦ Anemia 73% (normochromic normocytic)◦ Bone Pain 58% (typically chest/back)◦ Elevated Creatinine 48% ◦ Fatigue/Malaise 32%◦ Hypercalcemia 28%
CBC w diff, peripheral smear (rouleaux) Ca++, albumin, protein SPEP (87% sensitive); UPEP (75% sensitive) Bone Marrow Aspiration
◦ >10% plasmocytosis, may be focal Bone Scan
MAJOR CRITERIA I Plasmacytoma on tissue biopsy II Bone marrow with greater than 30% plasma cells III Monoclonal globulin spike SPEP w IgG peak > 3.5
g/dL or an IgA peak of > 2 g/dL, or UPEP (w amyloidosis) > 1 g/24hr
MINOR CRITERIA A Bone marrow with 10-30% plasma cells B Monoclonal globulin spike present but less than
category III C Lytic bone lesions D Residual IgM level less than 50 mg/dL, IgA level
less than 100 mg/dL, or IgG level less than 600 mg/dL
Supportive Therapy◦ Renal: plasmapheresis◦ Anemia: transfusion◦ Pain: analgesics, palliative radiation ◦ Spinal compression: immediate corticosteroids
Chemotherapy◦ Regimen based on pt age, staging, and prognostic
factors◦ VAD: vincristine, doxorubicin (Adriamycin), and
dexamethasone◦ Thalidomide ◦ Bortezomib◦ Revlimid