Multiple Myeloma - PDF

Multiple Myeloma  ~5,700 cases per year in the UK What is myeloma? Median age: 72 Cancer of plasma cells Leads to: Bone infiltration - fra...

Multiple Myeloma  ~5,700 cases per year in the UK What is myeloma? Median age: 72 Cancer of plasma cells Leads to: Bone infiltration - fractures (especially vertebral wedge fractures), hypercalcaemia - pain Renal damage Anaemia Immunosuppression - infections  2. MULTIPLE MYELOMA– EPIDEMIOLOGY Cancer of plasma cells in the bone marrow that produce monoclonal immunoglobulins/proteins Approximately 1-2% of all cancers Cancer of older adults Median age at diagnosis 65-74 10% are 50%, IgA 20-25%,  Multiple Myeloma Clinical manifestations are related to malignant behavior of plasma cells and abnormalities produced by M protein plasma cell proliferation: multiple osteolytic bone lesions hypercalcemia bone marrow suppression ( pancytopenia ) monoclonal M protein decreased level of normal immunoglobulins hyperviscosity  Multiple Myeloma Clinical symptoms: bone pains, pathologic fractures weakness and fatigue serious infection renal failure bleeding  Multiple Myeloma Laboratory tests: ESR > 100 anaemia, thrombocytopenia rouleaux in peripheral blood smears marrow plasmacytosis > 10 -15% hyperproteinemia hypercalcemia proteinuria uraemia  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  Treatment of Multiple Myeloma Patients < 65 - 70 years – high-dose therapy with autologous stem cell transplantation Patients > 65 years – conventional chemotherapy  Treatment of Multiple Myeloma Conventional chemotherapy – Melphlan + Prednisone Response rate 50-60% patients Long term survival 5-10% patients  Treatment of Multiple Myeloma Autologous transplantation – patients < 65-70 years – treatment related mortality 10-20% – response rate 80% – long term survival 40-50% Conventional allogeneic transplantation – patients < 45-50 years with HLA-identical donor – treatment related mortality 40-50% – long term survival 20-30%  Treatment of Multiple Myeloma Supportive treatment – biphosphonates, calcitonin – erythropoietin – immunoglobulins – plasma exchange – radiation therapy