Myeloma

1. http://crisbertcualteros.page.tl

2.  Malignant clonal proliferation of b-lymphocyte plasma
cells
 Normal: different plasma cells produce different
Immunoglobulin w/c are polyclonal
 Myeloma: single clone of plasma cell produce identical
Immunoglobulin- seen as monoclonal band or
paraprotein

3.  incidence: 5/100,000
 Peak: 70 years old

4. Symptoms
 Do serum protein electrophoresis & ESR on ALL >50yo
with BACKPAIN
 Osteolytic bone lesions- backache, pathological fx &
vertebral collapse
 Anemia, neutropenia & thrombocytopenia- results
from marrow infiltration by plasma cells

5. Symptoms
 Recurrent bacterial infections: due to immunoparesis
and neutropenia
 Renal impairment due to light chain deposition
precipitation of,light chains with the TammHorsfall
protein in the distal loop of henle
 Monoclonal Ig induce changes in the glomeruli

6. test
 CBC: NCNC anemia
 PBF: Rouleaux formation
 high ESR
 High Urea & Crea
 High Ca
 Normal ALP

7.  Screening Test: serum & urine electrophoresis
 B2 microglobulin: as a prognostic test
 XRAY: punch-out lytic lesions

8. Myeloma Diagnostic Criteria
 Monoclonal protein band in serum/urine
electrophoresis
 Increase plasma cell in BMA biopsy
 Evidence of end organ damage from MYELOMA:
1. Hypercalcemia
2. Renal insufficiency
3. anemia

9. treatment
 Supportive:
 Bonepain: analgesia, avoid NSAIDs
 Bisphosphonates: to tx hypercalcemia acutely
 Anemia: should be corrected with transfusion &
Erythropeitin
 Renal failure: rehydrate, ensure 3L/day
 Infections: broadspectrum ABX until C/S is out

10.  Chemotx: if unsuitable for intensive tx
 Melphalan + Prednisone

11. prognosis
 Median survival: 3-4years
 High b2- microglobulin worse prognosis
 Death infection/ renal failure

12. complications
 Hypercalcemia - rehydrate 4-6liter/day
- IV Bisphosphonate
 Hyperviscosity-reduced cognition, bleeding, disturbed
vision
 Spinal cord compression – Urgent MRI if suspected
- txt: Dexamethasone 8 - 16mg/24hrs