Multiple Myeloma

Dr. Ramesh Dhakhwa

 Multiple myeloma
• Definition:
• also known as plasma cell myeloma is a
multifocal malignant proliferation of plasma
cells derived from a single clone of cells (i.e.
monoclonal).
• Primarily affects elderly (peak incidence 5-6th
decade), incidence increases with age.
 Etiology
• Radiation exposure
• Epidemiologic factors: occupational exposure to
petroleum products, certain ocupations such as
farmers, wood workers and leather workers are more
prone
• Karyotypic abnormalities; eg; translocations, deletion
• Mutations in certain genes : eg tumor suppressor
genes(p53 gene); over expression of MYC and RAS
growth promoting oncogenes
 Clinical features
• Bone pain
• Susceptibility to infections; eg pneumonia, pyelonephritis
etc
• Renal failure
• Anaemia
• Bleeding tendencies
• Hyperviscosity syndrome: headache, fatigue, visual
disturbances and hemorrhage
• POEMS syndrome (polyneuropathy, organomegaly,
endocrinopathy, multiple myeloma and skin changes)
 Morphologic features
• Osseus (Bone marrow) lesions:
– Most commonly affected bones: skull, spine, ribs
and pelvis – myeloma cells
• Extraosseous lesions
– Blood: atypical plasma cells
– Myeloma kidney
– Myeloma neuropathy
– Systemic amyloidosis
– Liver, spleen involvement
 Laboratory tests:

• ESR > 100

• anaemia, thrombocytopenia
• rouleaux in peripheral blood smears
• marrow plasmacytosis > 10 -15%
• hyperproteinemia
• hypercalcemia
• Proteinuria : Bence Jones protein in urine
BMA plasma cells :
 Diagnosis
• Classic triad
– Marrow plasmacytosis of more than 10%
– Radiologic evidence of lytic bony lesions
– Demonstration of serum and/ or urine M
Component
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
Thank you