Multiple Myeloma

1. Mr. HIREN GEHLOTH
JG COLLEGE OF NURSING

2. INTRODUCTION
 Multiple myeloma is a malignant disease of the most
mature form of B lymphocyte, the plasma cell.
Plasma cells secrete immunoglobulins, proteins
necessary for antibody production to fight infection.
 The malignant plasma cells produce an increased
amount of a specific immunoglobulin that is
nonfunctional.
 Functional types of immunoglobulin are still
produced by non malignant plasma cells, but in
lower-than normal quantity.

3. Normal plasma cells are found in the bone marrow and are an important part
of the immune system. The immune system is made up of several types of
cells that work together to fight infections and other diseases.
Lymphocytes (lymph cells) are one of the main types of white blood cells in
the immune system and include T cells and B cells. Lymphocytes are in
many areas of the body, such as lymph nodes, the bone marrow, the
intestines, and the bloodstream.
When B cells respond to an infection, they mature and change into plasma
cells. Plasma cells make the antibodies (also called immunoglobulins) that
help the body attack and kill germs. Plasma cells, are found mainly in the
bone marrow. Bone marrow is the soft tissue inside bones. In addition to
plasma cells, normal bone marrow is also the home for other blood cells such
as red cells, white cells, and platelets.

6. TYEPS OF MULTIPLE MYELOMA
There are two main types of multiple myeloma. They’re categorized by
their effect on the body:
•Indolent myeloma: causes no noticeable symptoms. It usually
develops slowly and doesn’t cause bone tumors. Only small increases in
M protein and M plasma cells are seen.
•Solitary plasmacytoma: causes a tumor to form, typically in bone. It
usually responds well to treatment, but needs close monitoring.

7. Multiple Myeloma Features
1.Low Blood Counts
In multiple myeloma, the overgrowth of plasma cells in the bone marrow can
crowd out normal blood-forming cells, leading to low blood counts.
•This can cause anemia (a shortage of red blood cells). People with anemia
become weak and fatigued.
•Multiple myeloma can also cause the level of platelets in the blood to
become low (called thrombocytopenia). This can lead to increased bleeding
and bruising.
•Another condition that can develop is leukopenia (a shortage of normal
white blood cells). This can lead to problems fighting infections.

8. 2.Bone and Calcium Problem;
Myeloma cells also interfere with cells that
help keep bones strong. Bones are
constantly being remade to keep them
strong. Two kinds of bone cells work
together to keep bones healthy and strong:
•Osteoclasts break down old bone
•Osteoblasts lay down new bone

9. •Myeloma cells make a substance that tells the osteoclasts
to speed up dissolving the bone.
•So old bone is broken down without new bone to replace
it, making the bones weak and easy to break.
•Fractured bones are a major problem in people with
myeloma.
•This increase in bone break-down can also raise calcium
levels in the blood.

10. 3. INFECTION
• Abnormal plasma cells cannot protect the body from infections.
As mentioned before, normal plasma cells produce antibodies that
attack germs. In multiple myeloma, the myeloma cells crowd out
the normal plasma cells, so that antibodies to fight the infection
can’t be made.
• The antibody made by the myeloma cells does not help fight
infections.
• That’s because the myeloma cells are just many copies of the same
plasma cell – all making copies of the same exact (or monoclonal)
antibody.

11. 4. KIDNEY PROBLEM
• Myeloma cells make an antibody that can harm the kidneys,
leading to kidney damage and even kidney failure.

12. Clinical manifestation
Bone Problems
• Bone pain, which can be in any bone, but is most often in the
back, the hips, and skull
• Bone weakness, either all over (osteoporosis), or where there is a
plasmacytoma
• Broken bones (fractures), sometimes from only a minor stress or
injury

13. Increase blood level of Calcium
•Extreme thirst, leading to drinking a lot
•Urinating a lot
•Dehydration
•Kidney problems and even kidney failure
•Severe constipation,
•Abdominal (belly) pain
•Loss of appetite
•Weakness
•Feeling drowsy
•Confusion

14. Nervous system symptoms
If myeloma weakens the bones in the spine, they can collapse
and press on spinal nerves. This is called spinal cord
compression and can cause
•Sudden severe back pain
•Numbness, most often in the legs
•Muscle weakness, most often in the legs.

15. Nerve damage
Sometimes, the abnormal proteins produced by myeloma cells are toxic to
nerves. This damage can lead to weakness and numbness and sometimes a
“pins and needles” sensation. This is also called peripheral neuropathy.
Hyperviscosity
In some patients, large amounts of myeloma protein can cause the blood
to “thicken.” This thickening is called hyperviscosity. It can slow blood
flow to the brain and cause:
•Confusion
•Dizziness
•Symptoms of a stroke, like weakness on one side of the body and slurred
speech

16. Kidney Problems
Myeloma protein can damage the kidneys. Early
on, this doesn’t cause any symptoms, but signs
of kidney damage may be seen on a blood test
or a urine test. As the kidneys start to fail, they
lose the ability to get rid of excess salt, fluid,
and body waste products. This can lead to
symptoms such as:
•Weakness
•Shortness of breath
•Itching
•Leg swelling

17. ASSESSMENT AND DIAGNOSTIC EVALUATION
•An elevated monoclonal protein spike in the serum
(via serum protein electrophoresis), urine (via urine
protein electrophoresis), or light chain (via serum-
free light chain analysis) is considered to be a
major criterion in the diagnosis of multiple
myeloma.
• The diagnosis of myeloma is confirmed by bone
marrow biopsy.

18. MANAGEMENT
• For those who are not candidates for transplant, chemotherapy is the primary
treatment.
•Corticosteroids, particularly dexamethasone (Decadron), are often combined
with other agents (eg, melphalan [Alkeran], thalidomide [Thalomid],
lenalidomide [Revlimid], and bortezomib [Velcade]).
• Radiation therapy in combination with systemic treatment such as
chemotherapy.
•Vertebroplasty often performed when lytic lesions result in vertebral
compression fractures.

19. • Some bisphosphonates, such as pamidronate (Aredia) and zoledronic
acid (Zometa), have been shown to strengthen bone in multiple myeloma
by diminishing survival of osteoclasts.
• Plasmapheresis when patients have signs and symptoms of
hyperviscosity.
• Narcotic analgesics, thalidomide, and bortezomib for refractory
disease and severe pain.

20. NURSING MANAGEMENT
•Administer medications as recommended for pain relief.
•Carefully monitor for renal function and assess for gastritis.
• Educated about activity restrictions (eg, lifting no more than 10 lb, use of proper
body mechanics); braces are occasionally needed to support the spinal column.
• Teach patient to recognize and report signs and symptoms of hypercalcemia.
• Observe for bacterial infections (pneumonia); instruct patient in appropriate
infection prevention measures.
• Maintain mobility and use strategies that enhance venous return (eg,
antiembolism stockings, avoid crossing the legs).