Multiple Myeloma

1. Multiple Myeloma
Done by: Rawan ALSulaimani
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2. Outline :
Definition
Sign and symptoms
Test
Prognosis
 categories
Risk factors
Treatment
SOAP
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4. Multiple myeloma is a
cancer that begins in
plasma cells, a type of
white blood cell.
These cells are part of
immune system, which
helps protect the body
from germs and other
harmful substances.
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6. :Sign and symptoms
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7. Test :
 Blood and urine tests for monoclonal protein
 Bone marrow examination
 Imaging
 Genetic and chromosomal tests
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9. Prognosis:
The simplest measure of prognosis in MM is
based on blood levels of two markers:
beta-2-microglobulin and albumin.
In general, higher levels of beta-2-
microglobulin and lower levels of albumin
are associated with a poorer prognosis.
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10. Multiple myeloma may be classified into one of three categories:
• Monoclonal gammopathy of undetermined significance (MGUS) –
this condition is a sort of “pre-multiple myeloma,” meaning that
the excess protein is present but the level of plasma cells is low.
MGUS is by itself harmless, but about 16 percent of individuals
with it develop multiple myeloma over time.
 Solitary plasmacytoma - myeloma in only one spot or a single
tumor
 Asymptomatic or smoldering multiple myeloma – the blood tests
and bone marrow biopsy show the presence of multiple myeloma
but symptoms are not present.
 Symptomatic multiple myeloma
Staging a cancer means determining its extent. Is the multiple
myeloma confined to the bone marrow, or has the cancer spread
to other parts of the body like the bones? The stage of the cancer
determines what types of treatment will be needed. Because
multiple myeloma can be widespread, its staging is often based
on a rough measure of how much cancer is in the body.
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11. Risk factors:
As well as MGUS, certain things can increase
your risk of developing multiple myeloma,
including:
• age – your risk of developing multiple
myeloma increases as you get older; most
cases are diagnosed at around the age of 70,
and cases affecting people under 40 are rare
• gender – men are more likely to develop
multiple myeloma than women
• ethnicity – multiple myeloma is about twice
as common in black populations compared
with white and Asian populations
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12. When to start treatment? — Multiple
myeloma can remain stable for prolonged
periods of time. Individuals with early
myeloma who have no symptoms.
Individuals with a related condition, called
monoclonal gammopathy of undetermined
significance (MGUS), do not require
treatment, although long-term follow-up
is needed.
However, once symptoms develop,
treatment with one or more of the options
is recommended for almost all patients.
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13. Treatment:
Individuals with MGUS or no symptoms are usually observed
through regular physical examinations and blood tests, but
are not treated. Individuals who have symptoms may be
treated with:
 Chemotherapy drugs – these may include Cytoxan
(cyclophosphamide), Alkeran (melphalan), or
corticosteroids such as prednisone. The combination of
Thalomid (thalidomide) and Decadron (dexamethasone)
has also been an effective treatment.
 Radiation therapy
 Stem cell (bone marrow) transplantation – the individual
receives healthy bone marrow to replace the diseased bone
marrow.
 An anti-cancer drug called Velcade (bortezomib)
 In addition, the individual may receive treatment for
symptoms, such as receiving a blood transfusion to treat
anemia or antibiotics to treat infections
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14. Is stem cell transplantation an
option? —
Because of the risk of toxic and even fatal
complications related to stem cell
transplantation, not everyone with
multiple myeloma is a candidate for stem
cell transplantation.
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16. In most patients with multiple myeloma who have one or
more of the following factors are NOT considered eligible
for transplantation:
●Age >77 years
●Direct bilirubin >2.0 mg/dL (an elevated bilirubin level
indicates that the liver may not tolerate the high dose
chemotherapy required before transplantation)
●Serum creatinine >2.5 mg/dL unless on chronic stable
dialysis (; those with poor kidney function may not tolerate
high dose chemotherapy)
However, these factors are guidelines; the decision regarding
transplant eligibility should be made by the patient and
physician after discussing the potential risks, benefits, and
the needs and wishes of the patient.
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17. SOAP
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18. Case :
47 old female ,known osteoporotic
Presented with left femur fracture since 10
days
• Xray showed fracture with osteolytic
lesion
• Hx of NSID use
• Hx of weight loss and decrease appetite
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19. -Subjective:
MRN:2099303
Age :47 years old
Gender: female
CC (chief complaint): fracture in left thigh
since 10 days.
FH(family history):non
 SH(social history):married and non
smoker
PMH (past medical history): osteoporosis,
Vit.D def. and hyperuricemia.
Current medication: non
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20. -Obejective :
 PE( physical examination):
She was ill and lying on left side
High :154 Cm
Weight :66 Kg
Conscious alert oriented
Look in pain {pain score 8/10}
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Blood
pressure
Respiratory
rate
Pulse rateTempreture
170/80 mm hg20105
beat/min
37 C

21. Labs Result.
Hg
(11.7 -
15.5)
Na
(136-145)
7-18.7))BUNCreatinine
(.55 -1.0)
Date
9.1 g/dl133 mmol/l63 mg/dl2.12 mg/dl25/3
9 g/dl132 mmol/l65.84 mg/dl1.85 mg/dl26/3
9 g/dl130 mmol/l62 mg/dl1.24 mg/dl27/3
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22. Drugs such as thalidomide , lenalidomide ,
bortezomib , carfilzomib , ixazomib , and
pomalidomide have emerged as important
options for treatment of myeloma
Newer drugs
Chemotherapy drugs used in multiple myeloma
include melphalan , cyclophosphamide ,
Doxorubicin , and liposomal doxorubicin .
Chemotherapy
Corticosteroids include dexamethasone or
prednisone.
Corticosteroids
Stem cell transplantation can be done using one's
own stem cells (autologous) or using cells from a
close relative or matched unrelated donor
(allogeneic). In multiple myeloma, most
transplants performed are of the autologous kind
Stem cell
transplantation
Elotuzumab and daratumumab are antibodies
that target multiple myeloma cells
Immunotherapy
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Assessment:

23. :Treatment plan
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24. Thank You
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