17. Multiple Myeloma pathogenesis, diagnosis, differential diagnosis, treatment.

Question 1

what type of neolasm is multiple myeloma ?

Answer 1

B cell monoclonal neoplams in the bone marrow (not lymphoma)

Question 2

what s the age of diagnosisi of multiple myeloma

Answer 2

70 years old

Question 3

what is the etiology of multiple myeloma

Answer 3

radiation
benen metal
smoking
HV

Question 4

what is the clinical manifestation of multiple myleoma?

Answer 4

cyroglobulinema = rashes in hands , arthralgia , nephritis , neuritiisi

myeloma cells produce IL-6 which stimualte osteoclastst but not osteoblastst
therfore more breaking down of bone = bone pain

due to the overcrowdingthere is deficieny in other antibodies or pancytopnea = there is immunosuprresion so infections are common

amyloiodisi of light chain proteins can cause
there can e kidney damage = oligourea etc

primary amylidosis of light chain can cause heart failure and peripheral neuropathy

there is hyperviscosity syndrome 
causing peripheral neuropathy 
headach 
retinopathy 
mucosal bleeding from nose and gums 

there can be paraplegia = destruction of bone or direct compression of bone fragmnet

Question 5

which is the mostcommon subtype of immunolobulin porduced in multiple myeloma ?

Answer 5

IgG kappa

Question 6

what is the definte diagnosisi of multiple myeloma ?

Answer 6

one major an one minor

or 3 minor

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major criteria

in bone marrow biopsy plasmocytoma of over 10 percent

serology = igG more than 3.5g/sl
IgA more than 2g/dl

bence jones protein of over 1g/24 hrs

======

minor criteria
bone marrow biopsy plasma cytosisi 10-30 percent
igg less than given
lytic bone lesions
all other atibodies are reduced to half of normal values

=========

Question 7

what are the other diagnostic modalities ?

Answer 7

CBC
normocytic normcochromic anemia
IL-6 levels , epo low due to kidney damage

ESR is very high

can be pnacytopnea

hypercalcemia

=====
x ray
osteolytic lesions
or pathologcalfracturs esp of the ribs

====
urine hypercalciurea

=====
serum electrophoreisis

Question 8

what is the diffrentaite diagnosis f multiple myeoma ?

Answer 8

indolent non hodgskin b lymphoma
secreting high amount IgM
WALDENSTROME MACROGLOBULINEMA

or primary amyloidosis

Question 9

what is the staging od multiple myeloma ?

Answer 9

stage 1
mass of les than 0.6 x 10 to the pwer of 12 /m2

less than 4g /24 hr of bence jones

igG less than 5g/dl
IgA less than 3g/dl

calcium serum less than 12mg/dl

only one lyetic lesion

hemoglobin more than 10g/dl

=======

stage 2

=====

stage 3
more than 1.2 x 10 to the power of 12 /m2

hemoglobin less than 8.5,g/dl

igG more than 7g/dl
IgA more than 5g/dl

mulitple lytic lesions

calcium in serum the same

Question 10

what is associated with good or bad prognosis?

Answer 10

bad
translocation in 14 :14
14:6
q23q23

intermediate 13q14

Question 11

what is theteratmnet of multiple myeloma ?

Answer 11

for stage 1 watch and wait

anything above
chemotherapy with thalidomides
proteasom inhibtoors

targeting bone marow envornmne
IKB kinase inhibitor

in young = autlogous stemcell transplant
and bisphospnates