Definition Origin Biochemical Profile of Multiple Myeloma

1. Multiple myeloma

2. What is multiple myeloma (MM)?
 MM is a group of diseases
characterized by proliferation of single
plasma cell clone (myeloma cell) to
cause overproduction of monoclonal
immunoglobulin molecules known as
paraprotein (myeloma M-protein)

3. What is the origin of M-protein?
% of patients:
 55% - IgG
 23% - IgA
 20% - Ig light chains
 2 % - IgD, IgM

4. Where are myeloma cells and
paraproteins localized?
Myeloma cells
 Bone marrow
 Blood
Paraprotein
 Blood
 Urine (light chain –
Bence- Jones protein)

5. What is biochemical profile of
multiple myeloma?
 Plasma cell > 10%
 Serum electrophoresis: M- band
(sharp peak in the gamma-globin
fraction)
 Hypercalciemia
 Normal Alkaline phosphatase
 20% of patients with light chain
paraprotein do not detect it in
serum but show presence of
Bence-Jones protein in the urine

7. Cytogenetic analysis of
chromosome

8. What are Bence-Jones proteins?
How are they detected by heating
test?
 The presence of specific
protein in the urine of
patient with MM was first
reported by Bence-Jones
in 1848.
 Bence-Jones protein is
immunoglobulin light
chain.
 Heat test: ppt at 40-50C
but dissolve on further
urine heating to boiling
point
 Henry Bence-Jones
(1813-1873) English
physician and chemist

9. Clinical features
Bone disease
Impaired renal
function
Anemia
Hypercalciemia
Chronic
infections

10. Bone disease – lytic lesions of
bone
 Activation of
osteoclasts
(increase
resorption)
 Inhibition of
osteoblasts
(decrease
formation)
 Pain, deformation

11. Impaired renal function
 Overflow proteinuria
 Multiple myeloma
may cause renal
tubular amyloidosis
 Obstruction of
lumen of nephrons
by paraproteins

12. Anemia
 Bone marrow erythropoietic cell are
replaced by the plasma cells, resulting
in anemia

13. Hypercalcemia