mutiple myeloma

Question 1

what is multiple myeloma characterized by

Answer 1

Multiple myeloma (MM) is a bone marrow cancer characterized by the accumulation of malignant plasma cells within the bone marrow microenvironment, monoclonal Ab in blood or urine, and associated organ dysfunction.

Question 2

what is the aetiology (cause) of MM?

Answer 2

The cause of MM is uncertain however radiation may be a factor and also genetics

Question 3

what does the pathophysiology ( disordered physiological proccess) of MM arise from

Answer 3

Arise from an asymptomatic premalignant (precancerous) proliferation of plasma cells derived from post-germinal-centre B cells.
Often immature and may have the appearance of plasma blasts.

Question 4

what is the genetic presentation of MM ?

Answer 4

Complex karyotype abnormalities with chromosomal deletion, and translocation, are observed in certain B-cell lymphomas.

Question 5

why does myeloma cell mutation occur ?

Answer 5

– Somatic mutation of immunoglobin genes - myeloma precursors are stimulated by antigens
- Myeloma proliferates (reproduces) slowly in the marrow
- And myeloma cells do not differentiate.

Question 6

what is multiple myeloma?

Answer 6

Multiple myeloma, also known as myeloma, is a type of bone marrow cancer

Question 7

what is the epidemiology ( distribution) of MM

Answer 7

It accounts for 1% of all types of malignant diseases and 10% of hematologic malignancies.

Question 8

what age in MM most likely to occur?

Answer 8

40 - 70 years old but more likely at seventh decade. uncommon under 40 years old

Question 9

what type of MM has younger sufferers

Answer 9

LCD and IgD

Question 10

what is the ratio between male to female patients?

Answer 10

1:6:1

Question 11

what is the most common type of myeloma

Answer 11

IgG

Question 12

how long do patients with IgG live after diagnosis?

Answer 12

1 to 3 years but longer with stem cell transplantation

Question 13

what is the major cause of death?

Answer 13

sepsis and renal insufficiency

Question 14

What are the signs and symptoms of mm

Answer 14

bone pain - typically in the back or chest. Weakness, fatigue and paleness due to anemia
some may have hepatomegaly or splenomegaly.

Question 15

What skeletal abnormalities are characteristics of MM

Answer 15

Osteoporosis and fractures

Question 16

what part of the body is most likely to have theses skeletal abnormalities?

Answer 16

Skull, thoracic cage, pelvis, and proximal humeral and femurs

Question 17

what percentage of MM patients have skeletal abnormalities

Answer 17

90%

Question 18

what are the hematological features of MM?

Answer 18

Increased number of plasma cells in bone marrow aspirate and/or biopsy.
Disorder involves other tissues
Anaemia includes bleeding, qualitative platelet abnormalities, inhibition of coagulation factors by M protein, and thrombocytopenia and intravascular coagulation may occur.

Question 19

what pathological (trait) features does MM ?

Answer 19

The bone marrow in multiple myeloma shows large numbers of plasma cells, with many abnormal forms

Question 20

what does the Immunohistochemical staining of MM show?

Answer 20

If the myeloma presents with antibody to CD138 it will reveal the numbers of plasma cells. ( refer to slide 18 for photo)

Question 21

what are other symptoms that may present as a result of MM?

Answer 21

acute renal failure and Proteinuria

Question 22

what is Proteinuria and why do MM patients have it?

Answer 22

Proteinuria is high levels of protein in your urine. MM patients have it due to excreting high levels of BJ proteins.

Question 23

Neurological features of MM?

Answer 23

Pain due to compression of spinal cord or nerves. Back pain, weakness or paralysis of the lower extremities and bowel or bladder incontinence .

Question 24

why are patients of MM more likely to get infectious diseases?

Answer 24

Defective antibody synthesis caused by the crowding out and suppression of normal plasma cell precursors.

Question 25

what are the immunologic manifestation of MM

Answer 25

20% patients are diagnoses symptom less due to having high serum protein.
defects in hurmoral immunity but not cellular. this is because humoral immunity is disrupted due to the plasma cells

Question 26

what is the importance of Bence Jones proteins in MM?

Answer 26

they have been a diagnostic marker since mid 19th century