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Age group : 50 – 60 yrs
Sex : M:F- 3:1
Site : common in axial skeleton & flat bones than long
- spine , skull, pelvis , ribs , sternum,
Bone pain is the most common symptom , which is relieved
Persistent localised bone pain signifies pathological
No swelling / deformity unless there is pathologic al #
Compressive myelopathy due to vertebral collapse .
HALLMARKS OF MM
Weight loss , pallor, bleeding tendencies, fatigue
Susceptibility to bacterial infections
Bone destructions lytic lesions)
Presence monoclonal antibody
Haemogram shows anaemia , leucopenia ,
ESR is very high
Peripheral smear – NCNA with increased rouleaux formation.
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
Multiple punched out lesions in skull & other flat bones.
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
S. beta 2 microglogulin is the single most powerful
predictor of survival.
(DURIE & SALMON)
1.BM plasmacytosis ( > or = 30% BM
2.Monoclonal globulin spike Ig G or Ig A
3.Light chain excretion in urine ; > or = 1g/24
4.Biopsy proven plasmacytoma
1.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
“Watchful waiting", where the progress of the disease is
• Melphalan, prednisone, thalidomide (MPT)
• Bortezomib (Velcade), melphalan, prednisone (VMP)
• Lenalidomide plus low-dose dexamethasone
• Every 3-4 weeks for 6-12 cycles.
• Severe bone pain , pathological # , tumor
Bone marrow transplantation
Bisphosphonates (e.g. pamidronate or zoledronic acid) are
routinely administered to prevent fractures and
erythropoietin to treat anemia.
Pathological # prevented by internal splinting of affected
#s managed surgically by internal fixation .
Treatment of other complications.
In established cases survival is 2-3 yrs