Multiple myeloma Dr bandar ghazal Plasma cells generated

Multiple myeloma Dr. bandar ghazal

• Plasma cells generated from B lymphocyte in bone marrow , which in turn produce antibodies. • Multiple myeloma is also known as ( plasma cell myeloma ) , it’s a cancer of plasma cells , these myeloma cells produce abnormal immunoglobulins - Ineffective immunoglobulins - Infiltration of bone marrow , thus suppressing other bone marrow function. - Lytic bone formation and destruction of bone - Over production of monoclonal protein or paraproteins

• Normal plasma cells are large lymphocyte with abundant cytoplasm • Normal plasma cell produce : Normal IG g , IG A , IG D , IG M , IG E These Igs travel into blood stream and lymphatic system to the site of target antigen Each antibody composed of 2 heavy chains and 2 light chains. Light chains (kappa , lambda )with each antibody one type of light chain is involved in structure

Risk factors Radiation Obesity Family history Chemicals (pesticide ), petroleum products (benzene ) • Increasing age : 5 th – 7 th decade • Kaposi's sarcoma herpes virus • Male : female ( 2: 1 ) • •

MM pathophysiology • Clinical features and pathology of myeloma are due to : Tissue infiltration( bone marrow suppression , amyloidosis , lytic lesion , pathological fracture , bone pain ) Plasmacytoma is a single tumor present in soft tissue or bone Monoclonal gammopathy of undetermined significance Marrow plasma cells < 10% + no symptoms + no end organ damage +paraproteins < 3 gms /dl Plasmacytoma with bone marrow infiltration more than 10% and called MM • • Production of large amount of paraproteins (myeloma kidney due to light chain deposition and high Ca , hyper viscosity , DVT , weight loss ) • Impairment of immunity ( thus predispose PT to infection )

Presentation Asymptomatic Symptomatic • No symptoms Implies to end organ damage CRAB • Difference between them is in prognosis • • Ca level is increased RF Anemia Bone lesion

diagnosis • • • CBC ESR BLOOD FILM KFT , urine analysis Total protein , albumin Ca , LDH , alkaline phosphatase B 2 microglobulin 24 hr urine collection for light chain and Bence jones proteins Electrophoresis , Paraproteins more than 3 g / dl Immunofixation Bone marrow aspirate and Bx Xray , CT , MRI

Prognosis • Without treatment survival is 7 months • With treatment 5 year survival is 50 %