MULTIPLE MYELOMA

DEFINITION
Multiple myeloma is a malignant B-cell
lymphoproliferative disorder of the marrow,
with plasma cells predominating.
EPIDEMIOLOGY
Median age at diagnosis
is approximately 70 years
<65 years of age : 37%
65-74 years of age : 26%
>75 years of age : 37%
PATHOGENESIS
chromosomal translocations on chromosome
14 (q32.33) and chromosome 4p16.3. This
process results in the deregulation of genes
key role in determining tumor progression

CLINICAL FEATURES
Anemia 73 %
Bony lesions 80%
Bone Pain 58%
Renal Impairment 20-40%
Hypercalcemia is uncommon
The patient presents with weakness, backache,
bone pain or a pathological fracture.
Myeloma is one of the commonest causes of
osteoporosis and vertebral compression fracture
in men over the age of 45 years.
Hypercalcaemia thirst, polyuria and abdominal
pain.
In late cases signs of cord or nerve root
compression
vertebrae (most common)
ribs
skull
shoulder girdle
pelvis
long bones
extra skeletal structures-rare

Distribution of Multiple Myeloma
DIAGNOSIS
Normal marrow cells are largely replaced by
plasma cells, including forms with multiple
nuclei, prominent nucleoli, and cytoplasmic
droplets containing immunoglobulin.
Multiple myeloma
(bone marrow aspirate)
X-rays
Generalized osteoporosis
large colony of plasma cells solitary tumour
(plasmacytoma) in one of the bones
The classical lesions multiple punched-out
defects with soft margins (lack of new bone)
in the skull, pelvis and proximal femur, a
crushed vertebra, or a solitary lytic tumour in
a large-bone metaphysis
TREATMENT AND PROGNOSIS
Symptomatic Therapy
pain control and, treatment of pathological fractures.
Specific therapy
conventional chemotherapy has shown no benefit
immunomodulatory drugs to delay the progression
from asymptomatic to symptomatic myeloma
The prognosis in established cases is poor, with a
median survival of between 2 and 5 years.
ALHAMDULILLAH