Multiple myeloma overview
|
Multiple myeloma Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Multiple myeloma overview On the Web |
|
American Roentgen Ray Society Images of Multiple myeloma overview |
|
Risk calculators and risk factors for Multiple myeloma overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Multiple myeloma is a type of cancer of plasma cells which are immune system cells in bone marrow that produce antibodies. Its prognosis, despite therapy, is generally poor, and treatment may involve chemotherapy and stem cell transplant. It is part of the broad group of diseases called hematological malignancies.
Pathophysiology
It is a disorder affecting post germinal center B lymphocytes. A chromosomal translocation between the immunoglobulin heavy chain gene and one of many oncogenes leads to dysregulated multiplication of plasma cells. This leads to both localised damage, resulting in punched out bony lesions as well as various organ damage and other symptoms.
Risk Factors
The exact etiology behind multiple myeloma is not known but a number of risk factors are implicated, most commonly carcinogenic chemicals.
Differential Diagnosis
It needs to be differentiated from other plasma cell disorders such as Waldenstrom's hypergammaglobulinema and monoclonal gammopathies of uncertain origin as well as lytic bony lesions.
Epidemiology and Demographics
It is the second most common blood cancer after non-Hodgkin's lymphoma. It is typically a disease of old age,however recent trends indicate earlier involvement as well and is slightly more prevalent in men than women. The average survival is about 3 years. About 43.5% survive after 5 years as per a census conducted from 2003 to 2008. There are an estimated 77,617 people currently living with myeloma in the United States.[1]
Natural History
A number of organ systems are commonly involved, the most common symptoms being bone pain usually involving the spine and the ribs. These frequently lead to pathological fractures and resultant hypercalcemia. Also common are infections such as pneumonias and pyelonephritis. Renal failure from hypercalcemia and Bence Jones protein filtration, anemia from suppressed bone marrow production and neurological symptoms from brain metastasis are also prominent.
According to a report published by National Cancer Institute there is a 43.25 chance of 5 year survival.[2]
Complications associated with multiple myeloma include renal failure, hematologic complications, infections, bony and neurological complications.
Staging
International Staging System for myeloma, based on β2-microglobulin (β2M) levels and serum albumin levels, was published by International myeloma working group in 2003 and is the most widely used staging system. It is used for both guiding treatment as well as predicting prognosis.[3]
Symptoms & signs
The sign and symptomatology associated with multiple myeloma is most commonly assocaited with following 4 systems: Calcium (elevated), Kidneys (renal failure), blood (anemias) and cells and Bones (fractures and pains).
Some of the most common symptoms include weakness, bone pains, back pain, numbness and paresthesia, bleeding and recurrent infections.
Mst common signs include pallor, pain without tenderness, altered sensations on neurological examination etc.
Diagnosis
The most frequently advised tests are complete blood count (CBC), erythrocyte sedimentation rate (ESR), Basic metabolic panel, electrophoresis, immunohistochemistry and imaging procedures like X ray, CT scans and MRI's.
Treatment
The treatment of multiple myeloma is based on differentiating suitability for transplantation or not. Those who are candidates for transplantation are treated with a combination of dexamethasone and one of the following lenalidomide/bortezomib. Alkylating agents are usually avoided in such candidates. Several other agents are also used these include thalidomide, prednisone, melphalan etc.
References
- ↑ "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.
- ↑ "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.
- ↑ Greipp PR, San Miguel J, Fonseca R, Avet-Loiseau H, Jacobson JL, Rasmussen E, Crowley J, Durie BMG. Development of an international prognostic index (IPI) for myeloma: report of the international myeloma working group. Hematology Journal 2003;4:S42. NLM ID 100965523.