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Multiple Myeloma: Diagnosis and Treatment
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| - | Multiple Myeloma Morning Report July 21, 2009 Lindsay Kruska |
| - | Multiple Myeloma Neoplastic proliferation of single clone of plasma cells producing monclonal immunoglobulin Cause unknown Radiation and solvents ?associated 1% malignancy, 10% hematologic malignancy in US Incidence 4-5/100,000 Median age presentation 60-66y, rare |
| - | Presentation: Symptoms Suspected usually due to widely varied symptoms (>6mo in 40%) Bone pain (67%) Weakness and Fatigue (30%) Weight loss (24%) Asthenia (14%) Dyspnea (4%) Fever ( |
| - | Presentation: Signs Physical Exam Pallor Organomegaly, palpable LN rare ( |
| - | Work up CBC with diff, smear Anemia, rouleaux Chemistries Ca, Creatinine, Total protein SPEP with immunofixation (87% sensitive) UPEP (24h urine) (75% sensitive) Serum light chains Beta-2 microglobulin Bone marrow biopsy Bone survey, occasionally advanced imaging |
| - | SPEP Electrophoresis Immunofixation |
| - | Bone Marrow Biopsy Marrow plasmacytosis (>10%) CD138+, monoclonal Focal BM involvement 10% require multiple biopsies |
| - | Bony involvement |
| - | Diagnosis Presence of serum and/or urine monoclonal protein IgG (53%), IgA (25%), IgD (1%) Free light chains (20%) Clonal plasma cells or plasmacytoma End organ damage HyperCa, Renal failure, Anemia, Lytic Bone lesions |
| - | Main Differential Diagosis: Elevated M protein MGUS (1%/year) Absence of symptoms M protein |
| - | Differential Also Includes Other lymphoid neoplasms CLL B and T cell lymphomas Non lymphoid neoplasms Breast Ca CML Breast and colon cancer Cirrhosis Sarcoidosis Gaucher’s disease Pyoderma gangrenosum Autoimmune conditions Myasthenia gravis Rheumatoid arthritis Cold agglutinin disease Several rare skin DO |
| - | Staging Durie-Salmon staging (Stages I-III, a/b), 1975 M protein Serum Calcium Radiographic Bone Involvement Hemoglobin Renal failure International Staging System (Stages I-III), 2005 Serum beta2 microglobulin Albumin |
| - | Therapy Supportive care Hypercalcemia/bone involvement: usual therapies, analgesia, occ XRT Renal involvement: adequate hydration, ?plasmapheresis Low threshold for infectious complications Hyperviscosity: plasmapheresis Neurologic compromise: palliative radiation Anemia: transfusion Initation of specific therapy Chemotherapy Thalidomide Dexamethasone Melphalan/prednisone Bortezomib (proteasome inhibitor) HSCT |
| - | Prognosis Usually fatal 10-20% mortality within first 2 months Mean survival 4-5y 5y survival 31%, 10y 10%, 15y 4% Delay in diagnosis associated with negative impact on disease course Lead time bias Improved survival with therapy including HSCT Major causes of death: progressive myeloma, renal failure, sepsis, therapy related acute leukemia or myelodisplasia; 25% die of age related illnesses |
| - | References Fauci, et al. Harrison’s Internal Medicine. 17th edition. Abeloff, et al. Abeloff's Clinical Oncology, 4th ed. Up to Date. www.utdol.com |
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Multiple Myeloma
Mar 23, 2019
1.05k likes | 2.98k Views
Multiple Myeloma. Definition: B-cell malignancy characterised by abnormal proliferation of plasma cells able to produce a monoclonal immunoglobulin ( M protein ). Incidence: 3 - 9 cases per 100000 population / year. More frequent
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- normal immunoglobulins
- multiple myeloma
- undetermined significance
- protein igg 3
- light chain 1g dl
Presentation Transcript
Multiple Myeloma Definition: B-cell malignancy characterised by abnormal proliferation of plasma cells able to produce a monoclonal immunoglobulin ( M protein ). Incidence: 3 - 9 cases per 100000 population / year. More frequent in elderly with modest male predominance
Multiple Myeloma Clinical forms: multiple myeloma solitary plasmacytoma plasma cell leukaemia M protein: is seen in 99% of cases in serum and/or urine IgG > 50%, IgA 20-25%, IgEiIgD 1-3% light chain 20% 1% of cases are nonsecretory
Multiple Myeloma Clinical manifestations are related to malignant behaviour of plasma cells and abnormalities produced by M protein plasma cell proliferation: multiple osteolytic bone lesions. hypercalcemia. bone marrow suppression ( pancytopenia ). monoclonal M protein decreased level of normal immunoglobulins hyperviscosity
Multiple Myeloma Clinical symptoms: Bone pains, pathologic fractures Weakness and fatigue Serious infection Renal failure Bleeding diathesis
Multiple Myeloma Laboratory tests: ESR > 100 Anaemia, thrombocytopenia Rouleaux in peripheral blood smears Marrow plasmacytosis > 10 -15% Hyperproteinemia Hypercalcemia Proteinuria Azotemia
Diagnostic Criteria for Multiple Myeloma Major criteria I. Plasmacytoma on tissue biopsy ] II. Bone marrow plasma cell > 30% III. Monoclonal M spike on electrophoresis IgG > 3,5g/dl, IgA > 2g/dl, light chain > 1g/dl in 24h urine sample Minor criteria a. Bone marrow plasma cells 10-30% b. M spike but less than above c. Lytic bone lesions d. Normal IgM < 50mg, IgA < 100mg, IgG < 600mg/dl
Staging of Multiple Myeloma Clinical staging is based on level of haemoglobin, serum calcium, immunoglobulins and presence or not of lytic bone lesions correlates with myeloma burden and prognosis I. Low tumour mass II. Intermediate tumour mass III. High tumour mass subclassification A - creatinine < 2mg/dl B - creatinine > 2mg/dl
Multiple Myeloma Poor prognosis factors cytogenetical abnormalities of 11 and 13 chromosomes. beta-2 microglobulines > 2,5 ug/ml.
Disorder Associated with Monoclonal Protein Neoplastic cell proliferation multiple myeloma solitary plasmacytoma Waldenstrom macroglobulinemia heavy chain disease primary amyloidosis Undetermined significance monoclonal gammopathy of undetermined significance (MGUS) Transient M protein viral infection post-valve replacement Malignacy bowel cancer, breast cancer Immune dysregulation AIDS, old age Chronic inflamation
Monoclonal gammopathy of undetermined significance ( MGUS) M protein presence, stable levels of M protein: IgG < 3,5g IgA < 2g LC<1g/day normal immunoglobulins - normal levels marrow plasmacytosis < 5% complete blood count - normal no lytic bone lesions no signs of disease
Monoclonal gammopathy of undetermined significance ( MGUS) M protein 3% of people > 70 years. 15% of people > 90 years. MGUS is diagnosed in 67% of patients with an M protein. 10% of patients with MGUS develop multiple myeloma.
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Multiple Myeloma. The Struggle to Survive By Sandra Staheli. Do you Choose Treatment?. (Healthnfitness.6vdl.com, 2011). What D o Y ou Do With a Diagnosis?. What is Multiple Myeloma? (Harvard Women's Health Watch, 2011) Do you choose treatment? (American Cancer Society, 2011 )
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MULTIPLE MYELOMA. MULTIPLE MYELOMA. Median age at diagnosis, 65 years MM accounts for 1 - 2 % of all malignant diseases. MULTIPLE MYELOMA Monoclonal Gammopathies. M.Waldenström (2%). Solitary Plasmacytoma (2%). Others (5%). Smoldering Myeloma (3%). MGUS (55%).
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Multiple Myeloma. Morning Report July 21, 2009 Lindsay Kruska. Multiple Myeloma. Neoplastic proliferation of single clone of plasma cells producing monclonal immunoglobulin Cause unknown Radiation and solvents ?associated 1% malignancy, 10% hematologic malignancy in US
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Multiple Myeloma. MM. Plasma Cell Dyscrasias. Are characterized by clonal proliferation of immunoglobulin-secreting differentiated B lymphocytes and plasma cells. *Multiple myeloma is the most common malignant plasma cell dyscrasia .
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Multiple Myeloma. Plasma cell malignancy About 300 new cases in Norway each year Incurable Mean survival after diagnosis: 3-4 years Malignant plasma cells found in the bone marrow Osteolytic lesions common complication. Chromosomal-translocations associated with human cancer.
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Multiple Myeloma:
Multiple Myeloma:. Upfront studies. Antonio Palumbo. Levels of Evidence/Grades of Recommendation. Transplant. Patients < 65 years. VAD. VAD 3. DCEP. VDT-DPACE. HDCTX. CAD. VDT-DPACE. EDAP. DCEP. Total Therapy (TT) Trials: Treatment Schema.
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Multiple Myeloma. By Dr. Navinee Vongsupathai. Multiple Myeloma. Definition Causes and incidence Clinical feature Physical examination Diagnosis Classification and staging Threatment Prognosis. D efinition. Multiple myeloma : as myeloma or plasma cell myeloma
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Multiple Myeloma. Matt Elliott. Definition. Neoplastic proliferation of a single clone of plasma cells that produces a monoclonal immunoglobin Proliferation often results in osteolytic lesions, osteopenia, and/or pathologic fractures. Etiology. Not definitively known
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Smoldering Multiple Myeloma. To treat or not to treat, that is the question James R. Berenson, MD Institute for Myeloma and Bone Cancer Research West Hollywood, CA. Diagnostic criteria for diagnosis of smoldering MM- i.e. “Asymptomatic”. Smoldering or “Asymptomatic” MM.
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Multiple Myeloma Newsletter, Multiple Myeloma market, Multiple Myeloma market size, Multiple Myeloma market share, Mult
Multiple myeloma (MM) is a cancer of the blood that begins in the bone marrow. In myeloma, plasma cells develop into cancerous myeloma cells. Multiple myeloma is not widespread cancer; however, it has come to be considered as the second most widely diagnosed blood cancer in the United States. https://www.delveinsight.com/whitepaper-newsletter/multiple-myeloma-newsletter
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COMMENTS
Multiple myeloma is a cancer of plasma cells that results in overproduction of abnormal antibodies in the bone marrow. It commonly causes bone pain, fractures, anemia, and kidney problems. Risk factors include age over 60 and exposure to chemicals like pesticides, radiation, or certain industrial chemicals. Treatment may include chemotherapy ...
This document provides information on multiple myeloma. Key points include: - Multiple myeloma is a neoplastic proliferation of plasma cells producing monoclonal immunoglobulins that can cause symptoms. - It occurs more commonly in older adults, blacks, and those with radiation/chemical exposure. Common signs are anemia, bone pain, elevated ...
Multiple myeloma. Multiple myeloma is a cancer of plasma cells that produce abnormal proteins and can cause issues like kidney damage, anemia, and bone lesions. It is diagnosed based on blood tests, bone marrow biopsy, and imaging showing signs of bone damage. Prognosis depends on factors like age, kidney function, and chromosome abnormalities.
CLINICAL PRESENTATION OF MULTIPLE MYELOMA. Signs or symptoms related to the infiltration of plasma cells into the bone or other organs or to kidney damage from excess light chains: Anemia - 73%. Bone pain - 58%. Elevated creatinine - 48%. Fatigue/generalized weakness - 32%. Hypercalcemia - 28%.
EPIDEMIOLOGY. Cancer of plasma cells in the bone marrow that produce monoclonal immunoglobulins/proteins. Approximately 1-2% of all cancers. Cancer of older adults. Median age at diagnosis 65-74. 10% are <50. More common in African American individuals. Normal plasma cells Antibodies.
Multiple Myeloma: Overview and Objectives • At the end of this presentation, the participant should be able to: • Describe the Pathobiology of Multiple Myeloma, • Identify criteria for diagnosis of Multiple Myeloma, • Describe complications of Myeloma and identify appropriate interventions, • Discuss supportive care measures for ...
Presentation on theme: "Multiple Myeloma: Diagnosis and Treatment"— Presentation transcript: ... Download ppt "Multiple Myeloma: Diagnosis and Treatment" Similar presentations . My Treatment Approach to Hairy Cell Leukemia Rahul R. Naik, MD, Alan Saven, MD Mayo Clinic Proceedings Volume 87, Issue 1, Pages (January 2012) DOI: ...
The purpose of this guideline is to provide evidence-based recommendations for the treatment of newly diagnosed and relapsed multiple myeloma. The treatment of multiple myeloma has changed significantly in the past 5 years. Since 2015, four new drugs have been approved, thus providing more options and adding to the complexity of treatment options.
Epidemiology • Multiple myeloma is the most common primary cancer of bones in adults. • The annual incidence in the United States is 3 - 4 per 100,000 population. • Multiple myeloma represents 1% of all cancers diagnosed in the United States and 10% of all hematologic malignancies.
Learning Objectives. Distinguish MGUS from multiple myeloma. Understand the overall prognosis and management of patients with multiple myeloma. Monoclonal Protein identified on SPEP or FLC. Assess for CRAB features, order: CBC. Creatinine. Ca2+. For IgM subtype, assess for lymphadenopathy and splenomegaly.
MULTIPLE MYELOMA. Additional Therapies • Monoclonal Antibodies • Bispecific Monoclonal Antibodies • CAR-T Cellular Therapy. Offidani M, Corvatta L, Morè S, Olivieri A. Novel Experimental Drugs for Treatment of Multiple Myeloma. J Exp Pharmacol. 2021 Mar 9;13:245-264. doi: 10.2147/JEP.S265288. PMID: 33727866; PMCID: PMC7955760.
This document provides an overview of multiple myeloma, including its definition, clinical presentation, workup, staging, management, and treatment regimens. Key points include: - Multiple myeloma is a malignant neoplasm of plasma cells that accumulate in the bone marrow, leading to bone destruction.
multiple myeloma.ppt - Free download as Powerpoint Presentation (.ppt), PDF File (.pdf), Text File (.txt) or view presentation slides online. The document introduces plasma cells and plasma cell neoplasms. It describes the classification of plasma cell neoplasms including monoclonal gammopathy of undetermined significance (MGUS), macroglobulinemia, and multiple myeloma.
Multiple myeloma ppt - Free download as Powerpoint Presentation (.ppt / .pptx), PDF File (.pdf), Text File (.txt) or view presentation slides online. Multiple myeloma is a cancer formed by malignant plasma cells that grow out of control and form tumors in bone marrow. It is defined by having more than one plasma cell tumor, unlike a solitary plasmacytoma.
Presentation Transcript. Multiple Myeloma. Multiple Myeloma • Definition: Malignant proliferation of plasma cells derived from a single clone • Etiology: radiation;mutations in oncogenes; familial causes;role of IL 6 • Incidence/Prevalence: 14,400 cases in 1996; incidence 30/1,00,000 • Incidence increases with age • Males> females ...
Multiple Myeloma.ppt - Free download as Powerpoint Presentation (.ppt), PDF File (.pdf), Text File (.txt) or view presentation slides online. Multiple myeloma is a type of blood cancer where plasma cells in the bone marrow become cancerous and multiply uncontrollably. It causes bones to weaken as the malignant plasma cells accumulate in the bone marrow.
This document discusses multiple myeloma (MM), a plasma cell malignancy characterized by proliferation of monoclonal plasma cells in the bone marrow. Key points include: MM commonly precedes other premalignant conditions like MGUS; genetic defects contribute to disease heterogeneity and drug resistance; MM causes skeletal destruction and can ...
Multiple myeloma (MM) The second most common adult haematological malignancy. MM is a clonal malignancy of terminally differentiated plasma cells. Multiple myeloma: Epidemiology and incidence • Annual incidence of approximately 30-50 per million. • Median age at presentation of about 70 years. Approximately 15% of patients are aged <60 ...
Multiple myeloma is a cancer of plasma cells that is characterized by malignant proliferation of a single clone of plasma cells in the bone marrow. It most commonly affects bones and can cause bone pain, fractures, anemia, renal failure and recurrent infections. Diagnosis involves blood and urine tests showing monoclonal proteins and bone ...
PowerPoint is the world's most popular presentation software which can let you create professional Multiple Myeloma powerpoint presentation easily and in no time. This helps you give your presentation on Multiple Myeloma in a conference, a school lecture, a business proposal, in a webinar and business and professional representations.
Presentation Transcript. Multiple Myeloma Cynthia Lan, MD Feb. 14, 2006. Introduction • Multiple myeloma is a disease of neoplastic B lymphocytes that mature into plasma cells which make abnormal amounts of immunoglobulin (Ig). • Clinical manifestations are heterogeneous and include tumor formation, monoclonal Ig production, decreased Ig ...
1 INTRODUCTION. Multiple myeloma (MM) is a malignant neoplasm characterized by the accumulation of plasma cells in the bone marrow, resulting in renal failure, hypercalcemia, bone destruction and anaemia due to marrow failure. 1 In the United States, MM accounts for approximately 1.8% of all cancers and 19.1% of hematologic malignancies. 2 The median age at MM diagnosis was 69, with the ...
570 likes | 1.01k Views. Multiple Myeloma. MM. Plasma Cell Dyscrasias. Are characterized by clonal proliferation of immunoglobulin-secreting differentiated B lymphocytes and plasma cells. *Multiple myeloma is the most common malignant plasma cell dyscrasia . Download Presentation. protein. bone marrow.
Presentation Transcript. Multiple Myeloma Definition: B-cell malignancy characterised by abnormal proliferation of plasma cells able to produce a monoclonal immunoglobulin ( M protein ). Incidence: 3 - 9 cases per 100000 population / year. More frequent in elderly with modest male predominance. Multiple Myeloma Clinical forms: multiple myeloma ...