Myeloma

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Myeloma

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Myeloma

  1. 1. http://crisbertcualteros.page.tl
  2. 2.  Malignant clonal proliferation of b-lymphocyte plasma cells Normal: different plasma cells produce different Immunoglobulin w/c are polyclonal Myeloma: single clone of plasma cell produce identical Immunoglobulin- seen as monoclonal band or paraprotein
  3. 3.  incidence: 5/100,000 Peak: 70 years old
  4. 4. Symptoms Do serum protein electrophoresis & ESR on ALL >50yo with BACKPAIN Osteolytic bone lesions- backache, pathological fx & vertebral collapse Anemia, neutropenia & thrombocytopenia- results from marrow infiltration by plasma cells
  5. 5. Symptoms Recurrent bacterial infections: due to immunoparesis and neutropenia Renal impairment due to light chain deposition precipitation of,light chains with the TammHorsfall protein in the distal loop of henle Monoclonal Ig induce changes in the glomeruli
  6. 6. test CBC: NCNC anemia PBF: Rouleaux formation high ESR High Urea & Crea High Ca Normal ALP
  7. 7.  Screening Test: serum & urine electrophoresis B2 microglobulin: as a prognostic test XRAY: punch-out lytic lesions
  8. 8. Myeloma Diagnostic Criteria Monoclonal protein band in serum/urine electrophoresis Increase plasma cell in BMA biopsy Evidence of end organ damage from MYELOMA:1. Hypercalcemia2. Renal insufficiency3. anemia
  9. 9. treatment Supportive: Bonepain: analgesia, avoid NSAIDs Bisphosphonates: to tx hypercalcemia acutely Anemia: should be corrected with transfusion & Erythropeitin Renal failure: rehydrate, ensure 3L/day Infections: broadspectrum ABX until C/S is out
  10. 10.  Chemotx: if unsuitable for intensive tx Melphalan + Prednisone
  11. 11. prognosis Median survival: 3-4years High b2- microglobulin worse prognosis Death infection/ renal failure
  12. 12. complications Hypercalcemia - rehydrate 4-6liter/day - IV Bisphosphonate Hyperviscosity-reduced cognition, bleeding, disturbed vision Spinal cord compression – Urgent MRI if suspected - txt: Dexamethasone 8 - 16mg/24hrs

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