1. Jesse C James MD AM Report May 7, 2010

2.  Proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein  Malignant plasma cells are responsible for clinical manifestations  Part of a spectrum of diseases ranging from monoclonal gammopathy of unknown significance to plasma cell leukemia  Presentations range from asymptomatic to severe complications

3.  MM accounts for 1% of all American cancers. More frequent in men than women. AfA>WA>AsA  Median age 66 ◦ Anemia 73% (normochromic normocytic) ◦ Bone Pain 58% (typically chest/back) ◦ Elevated Creatinine 48% ◦ Fatigue/Malaise 32% ◦ Hypercalcemia 28%

4.  CBC w diff, peripheral smear (rouleaux)  Ca++, albumin, protein  SPEP (87% sensitive); UPEP (75% sensitive)  Bone Marrow Aspiration ◦ >10% plasmocytosis, may be focal  Bone Scan

5.  MAJOR CRITERIA  I Plasmacytoma on tissue biopsy  II Bone marrow with greater than 30% plasma cells  III Monoclonal globulin spike SPEP w IgG peak > 3.5 g/dL or an IgA peak of > 2 g/dL, or UPEP (w amyloidosis) > 1 g/24hr  MINOR CRITERIA  A Bone marrow with 10-30% plasma cells  B Monoclonal globulin spike present but less than category III  C Lytic bone lesions  D Residual IgM level less than 50 mg/dL, IgA level less than 100 mg/dL, or IgG level less than 600 mg/dL

6.  Supportive Therapy ◦ Renal: plasmapheresis ◦ Anemia: transfusion ◦ Pain: analgesics, palliative radiation ◦ Spinal compression: immediate corticosteroids  Chemotherapy ◦ Regimen based on pt age, staging, and prognostic factors ◦ VAD: vincristine, doxorubicin (Adriamycin), and dexamethasone ◦ Thalidomide ◦ Bortezomib ◦ Revlimid