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    Multiple Myeloma: - Sahyuddin Tutik Harjianti

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    Irham Khairi
    Multiple myeloma is a cancer of plasma cells that results in 3 main abnormalities: 1) Increased plasma cells in the bone marrow suppressing normal blood cell production and causing anemia. 2) Bone destruction from osteoclast activating factor causing bone pain, fractures, and hypercalcemia. 3) Secretion of abnormal monoclonal proteins known as paraproteins, usually IgG or IgA, which can cause organ damage like hyperviscosity syndrome, kidney failure, and amyloidosis. Diagnosis is based on blood tests showing anemia, elevated calcium, paraproteins on serum protein electrophoresis, and bone marrow biopsy demonstrating malignant plasma cells. Treatment involves medications, radiation, preventing complications, and prognosis depends on factors like paraprote

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    Multiple Myeloma: - Sahyuddin Tutik Harjianti

    Uploaded by

    Irham Khairi
    18 views16 pages
    Multiple myeloma is a cancer of plasma cells that results in 3 main abnormalities: 1) Increased plasma cells in the bone marrow suppressing normal blood cell production and causing anemia. 2) Bone destruction from osteoclast activating factor causing bone pain, fractures, and hypercalcemia. 3) Secretion of abnormal monoclonal proteins known as paraproteins, usually IgG or IgA, which can cause organ damage like hyperviscosity syndrome, kidney failure, and amyloidosis. Diagnosis is based on blood tests showing anemia, elevated calcium, paraproteins on serum protein electrophoresis, and bone marrow biopsy demonstrating malignant plasma cells. Treatment involves medications, radiation, preventing complications, and prognosis depends on factors like paraprote

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    (21) Multiple Myeloma

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    Multiple myeloma is a cancer of plasma cells that results in 3 main abnormalities: 1) Increased plasma cells in the bone marrow suppressing normal blood cell production and causing anemia. 2) Bone destruction from osteoclast activating factor causing bone pain, fractures, and hypercalcemia. 3) Secretion of abnormal monoclonal proteins known as paraproteins, usually IgG or IgA, which can cause organ damage like hyperviscosity syndrome, kidney failure, and amyloidosis. Diagnosis is based on blood tests showing anemia, elevated calcium, paraproteins on serum protein electrophoresis, and bone marrow biopsy demonstrating malignant plasma cells. Treatment involves medications, radiation, preventing complications, and prognosis depends on factors like paraprote

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    18 views16 pages

    Multiple Myeloma: - Sahyuddin Tutik Harjianti

    Uploaded by

    Irham Khairi
    Multiple myeloma is a cancer of plasma cells that results in 3 main abnormalities: 1) Increased plasma cells in the bone marrow suppressing normal blood cell production and causing anemia. 2) Bone destruction from osteoclast activating factor causing bone pain, fractures, and hypercalcemia. 3) Secretion of abnormal monoclonal proteins known as paraproteins, usually IgG or IgA, which can cause organ damage like hyperviscosity syndrome, kidney failure, and amyloidosis. Diagnosis is based on blood tests showing anemia, elevated calcium, paraproteins on serum protein electrophoresis, and bone marrow biopsy demonstrating malignant plasma cells. Treatment involves medications, radiation, preventing complications, and prognosis depends on factors like paraprote

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    of 16

    MULTIPLE MYELOMA

    ______________ Sahyuddin Tutik Harjianti


    Subdivisi Hematologi & Onkologi Medik Bag. Ilmu Penyakit Dalam FKUH

    Malignant Plasma Cells in Marrow

    * Multiple Myeloma
    _________________________________ = Mieloma Multipel (MM) = Kahlers disease = Keganasan sel plasma

    * Pendahuluan
    _________________________________ MM = keganasan sel plasma 1. Terjadi perubahan pada SST 2. Osteolitik & destruksi tulang 3. Terbtknya para-protein (prot abn)

    1. Perubahan SST
    _________________________________ Jumlah sel plasma sangat meningkat Supresi mielopoesis secr humoral anemia keggl SST secr menyeluruh

    2. Destruksi tulang
    _________________________________ ok OAF (osteoclast activating factor) * nyeri tulang (bone-pain) * osteo porosis/osteolitik : tl axial, calvaria, vertb, prox tl panjang, iga * fraktur patologik Akibat erosi tulang hiperkalsemia

    3. Sekresi protein abnormal


    _________________________________ Sel plasma maligna mensekresi suatu para-protein = protein M (abnormal) Umumnya berbtk IgG atau IgA sindr.hiperviskositas

    3. Sekresi protein abnormal(2)


    _________________________________ Komponen rantai ringan (light-chain) dari Ig gagal ginjal (kdg2 diperberat oleh hiperkalsemia) Katabolisme para-protein amiloid gagal jantung & neuropati

    * Gbr. klinis
    _________________________________ Peny. lanjut usia (median : 60 th) Anemia, LED tinggi Nyeri tulang : costa, vertebra Fraktur patologik : colum femoris Ggl ginjal, kompresi med.spinalis

    * Gbr. Klinis (2)


    _________________________________ Sindr.hiperviskositas : perdrh.mukosa, nausea, vertigo, ggn visus, ggn jiwa. Pucat, nyeri tulang, neuropati Ggl jantung kongestif

    * Laboratorium
    _________________________________ Anemia ( normokrom ) LED sangat tinggi ( mis. 150 / 160 ) Hiperkalsemia ( Ca >> ) Proteinuria (Bence Jones protein) Elektroforesis protein serum abnormal (spike monoclonal pd beta atau gamma)

    Serum Protein Electrophoresis


    Normal Monoclonal Protein in Myeloma

    Kyle RA and Rajkumar SV. Cecil Textbook of Medicine, 22nd Edition, 2004

    * Terapi

    1. Simtomatik (bone-pain dsb) 2. Melphalan/Alkeran + prednisone Kombinasi kemotx (alkylating) 3. Radiotx local (nyeri/frakt patologik) 4. Hindari immobilisasi lama 5. Hindari dehidrasi

    * Prognosis
    _________________________________ Median survival : 3 thn Px lbh buruk pada : spikes paraprotein sangat tinggi, ggl ginjal, hiperkalsemia & ggn tulang yg ekstensif.

    * Prognosis (2)

    High Tumor Burden : spike IgG > 7 g/dl hematokrit < 25 % ca serum > 12 mg/dl atau lesi osteolitik > 3 lokasi median survival 1 thn.

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