1. MULTIPLE MYELOMA(MM)

2. MM
• Cancer of plasma cells
• Malignant B cell lymphoproliferative disorder of the marrow with
plasma cell predominating.
• Most common primary malignancy of the bone.
• Plasma cells comes from B lymphocytes and produce
antibodies(immunoglobulins)

3. MM
• Myeloma cells produce abnormal immunoglobulin.
Overproduction of monoclonal protein or paraprotein
Ineffective immunoglobulin
Leads to decreased bone marrow function
Destruction of bone tissue

4. MM
INCIDENCE
• Increase with age(5th -7th decade)
• Males>females(2:1)
• >40 yrs with new bone tumor should include in d/d of MM and
metastatic carcinoma.
• 1% of all malignancies and 13% of all hematologic cancers( whites)

5. RISK FACTORS
• Age >60
• Exposure to pesticides(DDT)
• Wood, leather,sheet metal and nuclear industry worker
• Petroleum (benzene0
• Kaposi sarcoma Herpes Virus (presence of IL-6 and HHV8)

6. MM: Pathophysiology
The pathological and clinical features of myeloma are due to :
1. Tissue infiltration
2. Production of large amount of paraprotein
3. Impairment of immunity
Plasma cells produce proteins (Antibodies).Antibodies attach to
foreign substances to fight infections and disease.
In MM, the body makes too many Plasma cells. These cells produce
antibodies that the body does not need.

7. Common sites for Bone involvement.
• Skull
• Spine(thoracis,Lumbar,Vertbrae0
• Pelvis
• Long bones
• Spinal cord

8. Clinical Manifestations of MM
• Bone pain ( lower back, long bones or ribs)
• G malaise, Weight loss
• Anaemia,thrombocytopenia..Bleeding
• Renal failure(light chains and amyloid deposition)
• Hypercalcemia (Nausea, fatigues,thirst )
• Hyperviscosity (headaches, bruising, ischemic neurologic symptoms0
• Hyperuricemia
• Infections
• Meningitis

9. Mechanism of disease
Plasma cell proliferation->anemia, BM suppression, infection risk
Osteoclasts ->bony lesions, fractures, vertebral collapse, spinal cord
compression
Paraprotein, hypercalcemia->renal failure
Hypercalcemia-> polyuria, thirst, drowsiness,coma
May be symptomatic or asymptomatic

10. DIAGNOSIS OF MM
• Symptomatic myeloma characterized by presence of ROTI and CRAB.
• ROTI > Myeloma Related Organ or Tissue Impairment
• CRAB
Calcium levels increased
Renal failure
Anemia
Bone lesion

11. Dx of MM
FBC – Normal or low
ESR,CRP- Eleveted
Blood films- Rouleaux formation,Mcarocytosis, MCells
Urea,Creatinine- Renal failure
Serum B2 microglobulin>2.5mg/L
Raised LDH
Serum Calcium- N or raised
S ALP-N
Total Protein-N
S Albumin –N or L

12. UA- N or H
BMA Or trephine – infiltration by plasma cells. Amyloid also may be
found
24hrs urine electrophoresis and immunofixation- light chain
excretion
SPE- monoclonal band
Xrayz
Immunohistochemistry
Monoclonal gammopathy

13. • Major diagnostic criteria (Triad of Myeloma)
Plasmacytoma- Biopsy
30% Plasma cells- BMA
Eleveted monoclonal immunoglobulin levels in blood or urine

14. MYELOMA CYTOGENETICS
del (13)
t(4;14)