This document summarizes key information about multiple myeloma (MM), including its characteristics, diagnosis, and treatments. MM is a type of cancer caused by uncontrolled plasma cell proliferation, resulting in monoclonal immunoglobulin production. It is characterized by low blood counts, bone problems, infections, kidney failure, and monoclonal gammopathy. Diagnosis involves medical history, physical exam, laboratory tests (including blood counts, protein electrophoresis), bone marrow biopsy, and imaging. Treatments discussed include chemotherapy regimens containing bortezomib, thalidomide, dexamethasone, and stem cell transplantation. The objective of the study was to analyze clinical characteristics of MM patients with two different lambda light chains.

2. TITULO PRINCIPAL
MARIA CAMILA RODRIGUEZ
MARIANA PATIÑO
Tercer Semestre – Medicina
UPB – Medellín
2015

3. INTRODUCTION
• MULTIPLE MYELOMA
Type of cancer
caused by the
uncontrolled
proliferation of
monoclonal plasma
cells
Resulting in the
production of monoclonal
immunoglobulin (Ig) and
substancial
immunosupression and
endorgan damage

4. INTRODUCTION
• MM is characterized by several features, including:
 Low blood counts.
 Bone and calcium problems.
 Infections.
 Kidney failure.
 Monoclonal gammopathy.
 Light chain amyloidosis.
 Solitary plasmocytomas.

5. INTRODUCTION
• COMPLICATIONS OF MM
RENAL DYSFUCTION
EXTRAMEDULLARY
PLASMOCYTOMA
(EMP)

6. INTRODUCTION
• HOW IS IT DIAGNOSED?
1. Medical history and physical examination
2. LABORATORY TESTS
 Blood counts
 Quantitative Igs
 Electrophoresis (SPEP, IFE, UPEP)
 Free light chains
 Beta-2-microglobulin
 Blood chemistry tests
3. BONE MARROW BIOPSY AND ASPIRATION
 Immunohistochemistry
 Flow citometry
 Cytogenetics
 FISH

7. INTRODUCTION
4. BIOPSY TESTS FOR AMYLOID
5. IMAGING TESTS
 Bone X-rays
 CAT scans
 MRI scans
 Positron emission tomography scans
 Echocardiogram
6. PROGNOSIS

8. INTRODUCTION
• LAMBDA CHAINS
Amino acid sequence
Light chain of immunoglobulins
Their main fuction is to
bind the antigen in the
outer part of the arm
that they conform with
the heavy chains right in
the variable region

9. OBJECTIVE
• The objective of the
study was to conduct a
restrospective analysis of
the clinical characteristics
of a group of patients
with multiple myeloma
who had two different
immunoglobulin Λ light
chains as determined by
immunofixation
electrophoresis (IFE).

10. MATERIALES Y METODOS

11. TRATAMIENTO
Régimen PD ± T (bortezomib y dexametasona con o sin talidomida).
Régimen PAD (bortezomib, doxorubicina y dexametasona).
Régimen VAD (vindesina, doxorubicina y dexametasona).
Régimen de TAD (talidomida, doxorrubicina y dexametasona).
Régimen TD ±CTX (talidomida, dexametasona con o sin ciclofosfamida).
ESTRATEGIAS DE
TRATAMIENTO
RADIOTERAPIA SCT TD± CTXTADVADPAD PD± T
EMP
APTOS
SIN
BORTEZOMIB
CON
BORTEZOMIB

12. TRATAMIENTO
Además de tratamiento antimieloma, todos los pacientes recibieron CUIDADOS DE APOYO
INTENSIVO, que incluyen:
• Hidratación intravenosa.
• Alcalinización de la orina.
• La corrección de la hipercalcemia.
• Interrupción de todos los agentes nefrotóxicos potenciales.
• Diálisis renal a los pacientes con disfunción renal grave.

13. PRUEBAS Y FUNDAMENTO
• IFE: Se utilizó para determinar las cadenas ligeras lambda de las inmunoglobulinas. Este
examen se emplea con mayor frecuencia para verificar los niveles de ciertos anticuerpos
asociados con MM y macroglobulinemia de Waldenstrom. Estos anticuerpos
abarcan IgG, IgM, IgA, formas de cadena ligera lambda y formas de cadena ligera kappa.
• FISH: Se utilizó para determinar que tenían anomalías t (4; 14), t (14; 16) o anomalías del 17p.
Este examen se utiliza para determinar translocaciones de los cromosomas.

14. RESULTADOS

15. DISCUSSION
NUMBER OF
REFERENCE
AUTHOR
WHAT HE SAID AGREED OR NOT
8 Yang GZ, et al
With the clinical
application of novel
strategies and agents
such as autologous
SCT and bortezomib,
this situation has
improved (about the
renal dysfunction).
9
Dimopoulus MA, et
al
The pathophysiology
of the most common
types of renal injury
observed in myeloma
is closely linked to the
renal handling of light
chains.

16. DISCUSSION
11 Bladé J; at al
In a study by Bladé
at al, EMP was
reported in 15-20%
of patients at
diagnosis and in an
additional 15% of
patients during
follow up.
12 Bladé J; at al
Another study
described a series
of 12 patients with
MM aged <40 years
with a high
incidence of EMP.

17. CONCLUTIONS
• This study is important to be the base of study in the future of MM
associated to immunoglobulin λ light chains and the next scientists could
find the cure of this pathology.
• The study couldn't find the cause of MM associated to immunoglobulin λ
light chains but this study could find relation of immunoglobulin λ light
chains and renal dysfunction and EMP.

18. CONCLUTIONS
• The change of the structure components of biomolecules like
immunoglobulins can cause severe problems in their function
and metabolism, that’s why molecular methods are so
important when we are looking for a diagnosis and a
treatment for some diseases like multiple myeloma.

19. CONCLUTIONS
• Alternating empirical treatments for different diseases that
don’t have a specific one is beneficial to understand the
effects of using certain specific drugs and methods, in order to
provide diversity of treatments to achieve the most effective
one.

20. Mapa conceptual: María Camila Rodríguez

21. Mapa conceptual: Mariana Patiño

22. BIBLIOGRAPHY
• Yang GZ, et al. Clinical characteristics of a gruop of patients with multiple
myeloma who had two different lambda light chains by immunofixation
electrophoresis: A retrospective study from a single center. Experimental
and therapeutic medicine. 9: 1895-1900, 2015.
• American Cancer Society. Multiple Myeloma. 2014.
• Palumbo, Antonio, M.D.; Anderson, Kenneth, M.D. Multiple Myeloma.
NEJM;364: 1046-60. 2011.
• Federal University of Agriculture, Abeokuta. Immunoglobulins: types,
functions structure and biomedical importance.
• MARTINEZ SÁNCHEZ, Lina María. Biología molecular. 8. ed. Medellín: UPB.
Fac. de Medicina, 2015.