Chapter 21

Multiple Myeloma
 Introduction
• Multiple Myeloma is a neoplastic disease
characterized by plasma cell accumulation in the
bone marrow.
 Multiple myeloma (MM) is characterized by the
neoplastic proliferation of a single clone of
plasma cells producing a monoclonal
immunoglobulin.
 The presence of monoclonal protein in the serum
and or urine and symptomatic patients, related
tissue damage.
2
Plasma Cell
 Multiple Myeloma: Incidence
The 5-year relative survival rate for MM is around
35%,

MM occurs in all races and all geographic

locations.

Slightly more frequent in men than in women

(1.4:1).

The median age at diagnosis is 66 years.

 Clinical Presentations and
Pathogenesis of Multiple Myeloma:
 Anemia; normocytic, normochromic anemia
present in 73%
 Bone pain; Bone marrow replacement
 Elevated creatinine; Renal failure: Kidney
damage
 Fatigue/generalized weakness; Weight loss
 Bone pain with lytic lesions
 Monoclonal protein: M-protein or paraprotein,
reflects the synthesis of Immunoglobulin from a
single clone of plasma cells.
Rouleaux Formation
Immunoglobulins
 Serum Protein Electrophoresis:
Normal & M-Spike
 Serum immunoglobulin are
polyclonal and represent the
combined output from
millions of different plasma
cells.
 A monoclonal band (M-
protein) reflects the synthesis
of immunoglobulin from a
single clone of plasma cells.
 This may occur as a primary
neoplastic disease or
secondary to a benign or
neoplastic disease affecting
the immune system.
 Multiple Myeloma
All 3 criteria must be met:
Presence of serum or urinary monoclonal protein.

Presence of clonal plasma cells in the bone marrow

or a plasmacytoma.

The presence of end organ damage felt related to

the plasma cell dyscrasia, such as:
• Increased calcium concentration
• Lytic bone lesions
• Anemia
• Renal failure
 Multiple Myeloma Evaluation
 Serum viscosity should be measured if the M-
protein concentration is high.
 Bone marrow aspiration and biopsy with
immunophenotyping, cytogenetics, and
fluorescence in situ hybridization (FISH).
 Metastatic bone survey with plain radiographs
including the femoral bones should be performed
in all patients.
 MRI, CT,
Bone Marrow
 Prognosis
 Poor prognosis (median survival 25 months):
t(4;14)(p16;q32), t(14;16)(q32;q23), and
-17p13
 Intermediate prognosis (median survival 42
months): -13q14
 Good prognosis (median survival 50 months):
all others
 MM: Initial Therapy
 The initial therapy of patients with symptomatic
myeloma varies depending on whether patients are
eligible or not to pursue autologous hematopoietic
cell transplantation.