its a short document for easy understanding of multiple myeloma without complication

1. Multiple
myeloma
Dr T.PRABHA
Department of prosthodontics
Tngdc,Chennai

2. Introduction
01
Epidemiology
02
Pathophysiology
03
Signs and symptoms
04
Investigation
05
Diagnosis
06
Prevention
07
Treatment
08
Dental importance
09
Prognosis
10
Reference
11

4.  Multiple myeloma is a cancer that forms in a type of white
blood cell called a plasma cell. Healthy plasma cells help you
fight infections by making antibodies that recognize and
attack germs.
 In multiple myeloma, cancerous plasma cells accumulate in the bone
marrow and crowd out healthy blood cells.
Rather than produce helpful antibodies, the cancer cells
produce abnormal proteins that can cause complications.
These proteins are called M protein
Introduction

6. Epidemiology
Globally, multiple myeloma affected 488,000 people
and resulted in 101,100 deaths in 2015
It usually occurs around the age of 60 and is more
common in men than women.
It is uncommon before the age of 40
The five-year survival rate is about 54%
• Black race. Black people are more likely to develop
multiple myeloma than are people of other races.
• Family history of multiple myeloma. If a brother,
sister or parent has multiple myeloma, you have an
increased risk of the disease

7. Pathophysiology

9. Signs and symptoms
• Calcium: serum calcium >0.25 mmol/l
(>1 mg/dl) higher than the upper limit of
normal or >2.75 mmol/l (>11 mg/dl)
• Renal insufficiency: creatinine clearance
<40 ml per minute or serum creatinine
>1.77 mol/l (>2 mg/dl)
• Anemia: hemoglobin value of >2g/dl
below the lowest limit of normal, or a
hemoglobin value <10g/dl
• Bone lesions: osteolytic lesions on skele
tal radiography, CT, or PET/CT

10. Investigation

11. Diagnosis

12. Diagnosis

13. Prevention
The risk of multiple myeloma can b
e reduced slightly by maintaining a
normal body weight
Obesity is related to multiple myel
oma with each increase of body m
ass index by five increasing the risk
by 11%.

14. Treatment
One of the first considerations in managing patients with multiple myeloma is to
determine if the patient is eligible for autologous hematopoietic cell
transplantation.
If institutional criteria are met (typically determined by age, renal function, and co
morbidities), then standard treatment is induction chemotherapy with a combina
tion of a proteasome inhibitor (e.g., bortezomib or carfilzomib), immunomodulat
ory agent (e.g., thalidomide, lenalidomide, or pomalidomide), and glucocorticoste
roid (dexamethasone).
The most common initial therapy choices are bortezomib + lenalidomide + dexa
methasone or cyclophosphamide + bortezomib + dexamethasone.
Induction therapy is given 4-6 cycles followed by autologous hematopoietic cell tr
ansplantation. Thereafter, many patients receive post-transplant therapy (also cal
led consolidation or maintenance therapy).
In patients not eligible for autologous hematopoietic cell transplantation, a prolo
nged course of initial chemotherapy with a doublet (bortezomib + dexamethason
e or lenalidomide + dexamethasone) or triplet (bortezomib + lenalidomide + dexa
methasone or cyclophosphamide + bortezomib + dexamethasone) is typically ad
ministered .

15. Treatment

16. Gene therapy
Ciltacabtagene autoleucel (Carvykti)
was approved for medical use in the
United States in February 2022.
Ciltacabtagene autoleucel is
indicated
for the treatment of adults with
relapsed or refractory multiple
myeloma after
four or more prior lines of therapy,
including a proteasome inhibitor, an
immunomodulatory agent, and an
anti-CD38 monoclonal antibody.

17.  Oral prophylaxis, hygiene instruction and elimination of sources of infection
within the mouth before beginning cancer treatment, can reduce the risk of
infectious complications.
 Before starting bisphosphonates therapy, the person's dental health should be
evaluated to assess the risk factors to prevent the development of
medication-related osteonecrosis of the jaw (MRONJ).
 If there are any symptoms or radiographic appearance of MRONJ like jaw pain,
loose tooth, mucosal swelling, early referral to an oral surgeon is recommended.
 Dental extractions should be avoided during the active period of treatment and
treat the tooth with nonsurgical root canal treatment instead.
Dental importance

18. Prognosis
Life expectancy is about 5.1 years, in
case of stage 1. The life expectancy for
Stage 2 is approximately 3 to 4 years
and in case of stage 3 the life
expectancy reduces to 2 years.
The prognosis without treatment
shows poor survival rate. About 15% of
patients with this disease die within 6
months without treatment

19. The Accuracy of any
laboratory result is
hinged on the
analyzing the right
sample on the right
patient at the right time.
Early diagnosis and
treatment will increase
the survival rate in any
pathology
Conclusion

20. References :-
Robbins And Kumar Basic Pathology
Textbook of Pathology - 8th Edition harsh mohan
Rajkumar SV. Multiple myeloma: Every year a new stan
dard? Hematol Oncol. 2019 Jun;37 Suppl 1(Suppl 1):62-
65. doi: 10.1002/hon.2586. PMID: 31187526; PMCID: P
MC6570407.
Rajkumar SV. Updated Diagnostic Criteria and Staging S
ystem for Multiple Myeloma. Am Soc Clin Oncol Educ B
ook. 2016;35:e418-23. doi: 10.1200/EDBK_159009. PMI
D: 27249749.
Kazandjian D. Multiple myeloma epidemiology and surv
ival: A unique malignancy. Semin Oncol. 2016 Dec;43(6)
:676-681. doi: 10.1053/j.seminoncol.2016.11.004. Epub
2016 Nov 10. PMID: 28061985; PMCID: PMC5283695.
Brigle K, Rogers B. Pathobiology and Diagnosis of Multi
ple Myeloma. Semin Oncol Nurs. 2017 Aug;33(3):225-2
36. doi: 10.1016/j.soncn.2017.05.012. Epub 2017 Jul 5.
PMID: 28688533.

21. THANK YOU