multiple myeloma
DESCRIPTION
TRANSCRIPT
MULTIPLE MYELOMA
Most common primary malignant tumor of bone.
Multiple myeloma is a malignant clonal proliferation of plasma cells in the bone marrow with lytic bone leisions.
TYPES
Multiple myeloma (50%)
Solitary myeloma (25%)
Myelomatosis (15%)
Plasma cell leukemia (1%)
Extra skeletal - nasopharyngeal / oral cavity
EPIDEMIOLOGY
Age group : 50 – 60 yrs
Sex : M:F- 3:1
Site : common in axial skeleton & flat bones than long bones.
- spine , skull, pelvis , ribs , sternum, proximal femur
CLINICAL FEATURES
Bone pain is the most common symptom , which is relieved by rest.
Persistent localised bone pain signifies pathological fracture.
No swelling / deformity unless there is pathologic al #
Compressive myelopathy due to vertebral collapse .
CLINICAL HALLMARKS OF MM
Weight loss , pallor, bleeding tendencies, fatigue
Susceptibility to bacterial infections
Hypercalcemia
Renal failure
Bone destructions lytic lesions)
Presence monoclonal antibody
INVESTIGATIONS
Haemogram shows anaemia , leucopenia , thrombocytopenia
ESR is very high
Peripheral smear – NCNA with increased rouleaux formation. Leucoerythroblastic picture.
Total protein increased with A:G reversal.
S.Ca is increased, ALP normal.
Electrophoresis on serum or urine shows ‘M’ band in the region of gamma globulin.
Urine may show Bence Jones protein.
Bone marrow – hypercellular with increased no. of plasma cells & myeloma cells.
Mature & Immature plasma cells with eccenteric nuclei and ‘cart-wheel appearance’ of nuclear chromatin
RADIOLOGICAL FINDINGS
Multiple punched out lesions in skull & other flat bones.
M M with pathological #
Pathological wedge collapse of vertebra, commonly thoracic spine. Pedicles usually spared.
Diffuse severe rarefaction of bones.
Erosion of borders of ribs.
CT & MRI
Bone scan in solitarybone lesions helps to detect other sites of involvement.
S. beta 2 microglogulin is the single most powerful predictor of survival.
DIAGNOSTIC CRITERIA (DURIE & SALMON)
Major criteria1.BM plasmacytosis ( > or = 30% BM plasma cells)
2.Monoclonal globulin spike Ig G or Ig A
3.Light chain excretion in urine ; > or = 1g/24 hrs.
4.Biopsy proven plasmacytoma
Minor criterias1.BM plasmacytosis ; 10-30 % BM plasma cells
2.Monoclonal globulin spike gut < for major criteria.
3.Lytic bone lesions
4.Decrease in normal Ig level.
Diagnosis - I major + 1 minor criteria
3 minor criteria that must include no. 1& no.2
TREATMENT “Watchful waiting", where the progress of the disease is monitored .
Chemotherapy • Melphalan, prednisone, thalidomide (MPT)• Bortezomib (Velcade), melphalan, prednisone (VMP)• Lenalidomide plus low-dose dexamethasone
• Every 3-4 weeks for 6-12 cycles.
Radiotherapy • Severe bone pain , pathological # , tumor lesions.
Bone marrow transplantationBisphosphonates (e.g. pamidronate or zoledronic acid) are routinely administered to prevent fractures and erythropoietin to treat anemia.
Pathological # prevented by internal splinting of affected part.
#s managed surgically by internal fixation .
Treatment of other complications.
In established cases survival is 2-3 yrs
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