What You Need to Know About Multiple Myeloma and How to Diagnose It

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Some facts about this disease:

  • Malignant disorder of plasma cells
  • Peak incidence between 60-70 years
  • Rare under the age of 30
  • Males are affected more than females.

Pathogenesis:

-The tissues are infiltrated by proliferating cells.

-One type of abnormal immunoglobulins (paraprotein) usually IgG or IgA.

-This paraprotein may cause auto-immune manifestations.

-The paraprotein may coat the platelets and coagulation factors.

-Production of incomplete immunoglobulins (light chain only) by plas. cells which are excreted in urine (Bence-Jones protein).

-Diminished production of normal immunoglobulins increases infections.

Clinical picture:

i- Skeletal:

  1. Bone aches and pathological fractures
  2. Multiple osteolytic lesions in the skull and osteoclast stimulation

ii- Neurological:

  1. Compression of spinal cord by vertebral lesion
  2. Infiltration of roots, nerves and muscles by plasma cells.

iii- Renal Failure: due to:

  1. Bence-Jones proteins: precipitated in kidneys
  2. Nephrocalcinosis: caused by hypercalcaemia
  3. Hyperuricaemia: due to destruction of plasma cells
  4. Amyloidosis of kidneys
  5. Pyelonephritis: due to susceptibility to infections

iv- Anemia: due to:

  1. BM (bone marrow) replacement by plasma cells
  2. BM inhibition by chemotherapy and radiotherapy
  3. Haemolysis caused by paraprotein
  4. Renal impairment

v- Bleeding Tendency due to:

  1. Coating of coagulation factors by paraprotein
  2. Coating of platelets by paraprotein

vi- Cardio-Vascular

  1. Raynoud’s phenomenon due to cold antibodies
  2. Hyperviscosity syndrome

vii- Others:

  1. Repeated infections
  2. Amyloidosis

Investigations:

1- Blood picture:

  • Anemia
  • Increased ESR

2- BM Examination:

Full of plasma cells

3- Biochemical:

  • Increased calcium in blood
  • Increased uric acid in blood
  • Alkaline phosphatase: normal

4- Immuno electrophoresis:

Shows marked increase in one type of immunoglobulins

5- Renal:

  • Bence-Jones proteins
  • Urine electrophoresis: for paraprotein and light chains
  • Kidney function tests: may be impaired

6- X-ray:

Multiple osteolytic lesions in bones especially in vertebrae, skull and pelvis.

Treatment:

1- Chemotherapy:

Melphalan or cyclophosphamide.

2- Radiotherapy:

To control tumour masses.

3- Symptomatic:

e.g. infection, renal failure and pain.

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Source by Sayed EL Assal