MULTIPLE MYELOMA -HEMATOLOGIC MALIGNANCY-DISEASE OF BONE MARROW - PLASMA CELL DISORDER PATHOLOGY, .CLINICAL FEATURES , AND ITS MANAGMENT REFERENCE HARRISON

2. SINGLE MYELOMA

3. INCIDENCE INCREASES WITH AGE
MEDIAN AGE OF DIAGNOSIS 70 YEARS
UNCOMMON UNDER 40 YEARS
MALES MORE COMMONLY AFFECTED
BLACKS HAVE TWICE INCIDENCE THAN
WHITES
ACCOUNTS FOR 13%OF ALL
HEMATOLOGIC CANCER IN WHITE AND
33% IN BLACKS
N-RAS, K-RAS AND B-RAF MUTATIONS
ARE MOST COMMON AND COMBINED
OCCUR IN OVER 40% OF PATIENTS

6. Proliferation of tumor cells, activation of osteoclasts
that destroy bone and suppression of osteoblasts
that form new bone

7. RADIOISOTOPIC BONE SCANNING IS LESS USEFUL IN DIAGNOSIS THAN IS PLAIN
RADIOGRAPHY.

11. OCCURS IN NEARLY 25% OF
MYELOMA PATIENTS
SOME RENAL PATHOLOGY IS NOTED
IN MORE THAN 50%
HYPERCALΙEMIA IS THE MOST COMMON CAUSE OF RENAL FAILURE
TUBULAR DAMAGE ASSOCIATED WITH THE EXCRETION OF LIGHT CHAINS IS ALMOST
ALWAYS PRESENT(ADULT FANCONI SYNDROME)
GENERALLY, VERY LITTLE ALBUMIN IS IN THE URINE BECAUSE GLOMERULAR FUNCTION IS
USUALLY NORMAL.

12. DECREASED ANION GAP [I.E., NA+ - (CL- + HC03-) ] BECAUSE THE M COMPONENT IS
CATIONIC, RESULTING IN RETENTION OF CHLORIDE
RENAL DYSFUNCTION DUE TO LIGHT CHAIN DEPOSITION DISEASE, LIGHT CHAIN
CAST NEPHROPATHY AND AMYLOIDOSIS IS PARTIALLY REVERSIBLE WITH EFFECTIVE
THERAPY.
HYPONATREMIA THAT IS FELT TO BE ARTIFICIAL (PSEUDOHYPONATREMIA) BECAUSE
EACH VOLUME OF SERUM HAS LESS WATER AS A RESULT OF THE INCREASED
PROTEIN

13. FANCONI
SYNDROME ANAEMIA

14. NORMOCYTIC NORMOCHROMIC

15. FAILURE OF ANTIBODY-COATED
PLATELETS TO FUNCTION PROPERLY
INTERACTION OF THE M
COMPONENT WITH CLOTTING
FACTORS
ANTIBODY TO CLOTTING FACTORS

16. NEUROLOGICAL SYMPTOMS

18. •Calcium level increased: serum calcium
>0.25mmol/L above the ULN
or>2.75mmol/L
•Renal insufficiency:
creatinine>173mmol/L
•Anaemia: hemoglobin 2g/dL below LLN
or Hb < 10g/dL
•Bony lesion

19. MGUS
Smoldering Myeloma
ASYMPTOMATIC
MM

21. Although ~1 % of patients per year with MGUS go on to develop myeloma, all myeloma
is preceded by MGUS.
MGUS MULTIPLE MYELOMA
•Non-IgG subtype，
•Abnormal kappa/lambda free light chain ratio
•Serum M protein > 15 g/L ( 1.5 g/dL) are
associated with higher incidence of progression
of MGUS to myeloma.
Absence of all three features predicts a 5% chance of progression, whereas higher risk
MGUS with the presence of all three features predicts a 60% chance of progression over
20 years

22. SMOLDERING MM MULTIPLE MYELOMA
•Bone marrow plasmacytosis >10%
•Abnormal kappa/lambda free light
•Chain ratio and serum M protein >30 g/L
(3 g/dL)
Patients with only one of these three features have a 25% chance of progression to MM
in 5 years,whereas patients with high-risk SMM with all three features have a 76%
chance of progression

25. WHAT ABOUT IgM?????

27. ß2- MICROGLOBULIN

30. SYNDROME
POLYNEUROPATHY ORGANOMRGALY ENDOCRINOPATHY M- PROTEIN SKIN CHANGES

31. HEAVY CHAINDISEASE
FRANKLIN’S DISEASE
SELIGMANN’S DISEASE