Multiple Myeloma

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Multiple Myeloma

• Matt Elliott

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Definition

• Neoplastic proliferation of a single clone of
  plasma cells that produces a monoclonal
  immunoglobin
• Proliferation often results in osteolytic
  lesions, osteopenia, and/or pathologic fractures

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Etiology

• Not definitively known
• Relation to radiation, benzene, organic solvents,
  herbicides, and insecticides has been proposed
• Chronic inflammatory diseases
• Kaposis sarcoma (HHV 8)
• Genetic?

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Epidemiology

• 1 of all malignant disease
• 10 of hematologic malignancies
• More frequent in men
• 2X as common in AA
• Median 66 years

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Manifestations

• Bone pain (60)- back or chest
• Reduction in height
• Weakness and fatigue (32)
• Weight loss (24)
• Pallor
• Radiculopathy- thoracic or lumbosacral area
• Infection- 45 of deaths w/i 60 days of diagnosis

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Infection

• Impaired lymphocyte function
• Suppression of plasma cell function with
  hypogammaglobulinemia
• Neutropenia and corticosteroid treatment during
  chemotherapy

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Organisms

• S. pneumoniae
• H. influenzae
• E. coli

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Bone Pain

• Radiographic abnormalities in 80
• Increased osteoclastic activity and decreased
  osteoblastic activity through release of cytokines

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Imaging

• Skeletal survey punched out lytic lesions,
  osteopenia, pathologic fractures.
• Skull, vertebral bodies, thoracic cage, pelvis,
  proximal humeri and femora
• MRI/CT commonly used in patients with no
  explanation for bone pain after survey
• Bone scanning not often used (detects
  osteoblastic activity)
• PET scanning possible in the future

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Renal Disease

• Renal failure common, d/t hypercalcemia or cast
  nephropathy

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Lab Findings

• Anemia
• Rouleaux
• Plasmacytosis
• Leukopenia and thrombocytopenia
• Monoclonal proteins
• IgG (52)
• IgA (21)
• Bence Jones (16)
• IgD (2)

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Bone Marrow Biopsy

• More than 10 plasma cells

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Treatment

• Autologous hematopoietic cell transplantation
  (HCT)
• Chemotherapy including corticosteroids
• Local radiation of bone lesions

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• QUESTIONS??

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