INTRODUCTION PATHOPHYSIOLOGY CAUSES STAGES SIGNS AND SYMPTOMS DIAGNOSIS RISK FACTORS TREATMENT COMPLICATIONS PROGNOSIS EPIDEMILOGY REFERENCES TABLE OF CONTENT.
Multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell. Plasma cells help you fight infections by making antibodies that recognize and attack germs. Multiple myeloma causes cancer cells to accumulate in the bone marrow, where they crowd out healthy blood cells. Rather than produce helpful antibodies, the cancer cells produce abnormal proteins that can cause kidney problems INTRODUCTION
B lymphocytes starts in the bone marrow and goes to the lymph node, and as it progresses it tends to display more proteins and more matured cells on their cell surface. When they are activated to secrete antibodies they are known as plasma cells. For multiple myeloma, it develops in b lymphocytes and after they have left a part of the lymph node known as the germinal center. The normal cell line mostly associated with MM cell is generally taken to be activated b cell memory or precursor to plasma cell PATHOPHYSIOLOGY
The immune system keeps the proliferation of B cells and the secretion of antibodies under tight control. When chromosomes and genes are damaged, often through rearrangement, this control is lost. Often, a promoter gene moves (or translocate) to a chromosome where it stimulates an antibody gene to overproduction. CONT’D
Multiple myeloma is a type of cancer. Cancer starts when the structure of the DNA in a cell is altered - a genetic mutation. The DNA (deoxyribonucleic acid) consists of a set of instructions for a cell, telling it when to grow, divide, die, etc. When there is a mutation in the DNA the instructions change, sometimes accelerating cell growth and stopping cells from dying. If new cells are created but the mature ones don't die, for example, an excess of mutated cells starts to build up. CAUSES.
The result is an uncontrollable reproduction of cells, which in the case of multiple myeloma leads to too many plasma cells inside the bone marrow - the soft, blood-producing tissue that fills in the center of most of our bones. Less than 5% of healthy bone marrow consists of plasma cells. For people with multiple myeloma more than 10% of the bone marrow consists of plasma cells. CONT’D
Unlike most other types of cancer, multiple myeloma is thought to spread through the bloodstream. Mutated cells may start off in the bone marrow of the spine, get into the bloodstream and travel to another part of the body, such as the hips or skull, and affect the bone marrow there. The disease is called multiple myeloma because it can rapidly spread to multiple parts of the body. Multiple myeloma's ability to rapidly move from one part of the body to another makes it very hard to find a complete cure. CONT’D
Smoldering: Multiple myeloma with no symptoms Stage I: Early disease with some symptoms. E.g fatigue, nausea etc Stage II: Multiple symptoms and more advanced disease. E.g weight loss, mental confusion etc Stage III: Multiple areas with multiple myeloma cells and more serious symptoms. E.g numbness, bone pain etc STAGES
Bone pain, especially in your spine or chest Nausea Constipation Loss of appetite Mental fogginess or confusion Fatigue Frequent infections Weight loss Weakness or numbness in your legs Excessive thirst SIGNS AND SYMPTOMS
Blood tests. Laboratory analysis of your blood may reveal the M proteins produced by myeloma cells. Another abnormal protein produced by myeloma cells — called beta-2-microglobulin — may be detected in your blood and give your doctor clues about the aggressiveness of your myeloma. Additionally, blood tests to examine your kidney function, blood cell counts, calcium levels and uric acid levels can give your doctor clues about your diagnosis. DIAGNOSIS
Urine tests. Analysis of your urine may show M proteins, which are referred to as Bence Jones proteins when they're detected in urine. Imaging tests. Imaging tests may be recommended to detect bone problems associated with multiple myeloma. Tests may include X-ray, MRI, CT or positron emission tomography (PET). CONT’D
Examination of your bone marrow. Your doctor may remove a sample of bone marrow for laboratory testing. The sample is collected with a long needle inserted into a bone (bone marrow aspiration and biopsy). In the lab, the sample is examined for myeloma cells. Specialized tests, such as fluorescence in situ hybridization (FISH) can analyze myeloma cells to understand their chromosome abnormalities. Tests are also done to measure the rate at which the myeloma cells are dividing. CONT’D
Age - 96% of cases are diagnosed in people over 45 years of age. 75% are diagnosed in people over 70 years of age. Genetic inheritance - people who have a close relative with multiple myeloma have a higher risk of developing it. Obesity – obesity is a risk factor for many cancers including multiple myeloma.. Diet - some studies have indicated that a diet low in fish and/or green vegetables may be linked to a higher multiple myeloma risk. Also males have more risk than females. RISK FACTORS
Biological therapy. Biological therapy drugs use your body's immune system to fight myeloma cells. The drugs thalidomide (Thalomid), lenalidomide (Revlimid) and pomalidomide (Pomalyst) enhance the immune system cells that identify and attack cancer cells. These medications are taken in pill form. Chemotherapy. Chemotherapy drugs kill fast-growing cells, including myeloma cells. Chemotherapy drugs can be given through a vein in your arm or taken in pill form. High doses of chemotherapy drugs are used before a stem cell transplant. TREATMENT
Stem cell transplantation. A stem cell transplant is a procedure to replace your diseased bone marrow with healthy bone marrow. Before a stem cell transplant, blood-forming stem cells are collected from your blood. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding your bone marrow. CONT’D
Corticosteroids. Corticosteroids, such as prednisone and dexamethasone, regulate the immune system to control inflammation in the body. They also are active against myeloma cells. Corticosteroids can be taken in pill form or administered through a vein in your arm. Radiation therapy. This treatment uses beams of energy, such as X-rays, to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells form a tumor (plasmacytoma) that's causing pain or destroying a bone. CONT’D
Because multiple myeloma can cause a number of complications, you may also need treatment for those specific conditions. For example: Bone pain. Pain medications, radiation therapy and surgery may help control bone pain. Kidney complications. People with severe kidney damage may need dialysis. Infections. Your doctor may recommend certain vaccines to prevent infections, such as the flu and pneumonia. Bone loss. Your doctor may recommend medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), to help prevent bone loss. Anemia. If you have persistent anemia, your doctor may recommend medications to increase your red blood cell count. COMPLICATION.
The prognosis of multiple myeloma is variable, depending on the approximate stage and response to therapy. However, there is no cure for the disease. For all patients the average 5-year survival rate is about 35%. Survival rates are higher in younger patients and lower in the elderly. Levels of C-reactive protein and beta-2 microglobulin have been used to predict survival times (for example, mean survival time in someone with both proteins levels less than 6 mg/L is 54 months and is 6 months if both are above 6 mg/L). Patients withtumour masses, kidney impairment, bence jones proteins and elevated blood calcium have a poor prognosis... PROGNOSIS
Multiple myeloma is the second most prevalent blood cancer (10%) after non-hodgkin lymphoma. It represents approximately 1% of all cancer deaths. Although the peak age of onset of multiple myeloma is 65 to 70yrs of age. Recent statistics indicates both increasing incidents and earlier age of onset. Multiple myeloma affects slightly more men than women. African Americans and Native Pacific Islanders have the highest reported incidence of this disease in the United States and Asians the lowest. Results of a recent study found the incidence of myeloma to be 9.5 cases per 100,000 African Americans and 4.1 cases per 100,000 Caucasian Americans. Among African Americans, myeloma is one of the top 10 leading causes of cancer death. EPIDEMIOLOGY
Raab MS, Podar K, Breitkreutz I, Richardson PG, Anderson KC (July 2009). "Multiple myeloma". Lancet 374 (9686): 324–39. doi:10.1016/S0140- 6736(09)60221-X. PMID 19541364.doi:10.1016/S0140- 6736(09)60221-X. PMID 19541364. ^ Jump up to: a b "SEER Stat Fact Sheets: Myeloma". NCI Surveillance, Epidemiology, and End Results Program. Retrieved 18 August 2014."SEER Stat Fact Sheets: Myeloma". NCI Surveillance, Epidemiology, and End Results Program. Retrieved 18 August 2014. Jump up ^ "SEER Stat Fact Sheets: Myeloma". NCI. Retrieved 18 June 2014."SEER Stat Fact Sheets: Myeloma". NCI. Retrieved 18 June 2014. ^ Jump up to: a b c International Myeloma Working Group (2003). "Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group". Br. J. Haematol. 121 (5): 749–57. doi:10.1046/j.1365- 2141.2003.04355.x. PMID 12780789.doi:10.1046/j.1365- 2141.2003.04355.x. PMID 12780789. REFERENCES