{"id":5355,"date":"2021-05-15T23:53:42","date_gmt":"2021-05-15T21:53:42","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/hematology\/hematological-oncology\/multiple-myeloma-and-waldenstroms-macroglobulinaemia\/"},"modified":"2021-05-19T19:44:09","modified_gmt":"2021-05-19T17:44:09","slug":"multiple-myeloma","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/plasma-cell-disorders-dyscrasias\/multiple-myeloma\/","title":{"rendered":"Multiple myeloma"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><div class=\"intro\">Multiple myeloma is a clonic proliferation of malignant plasma cells, producing excessive amounts of monoclonal antibodies (most commonly IgG).<\/div><\/p>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Background<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<ul class=\"wp-block-list\"><li>These plasma cells are usually monoclonal and therefore produce monoclonal immunoglobulin referred to as <strong>protein M\u00a0<\/strong>(M\u00a0as in\u00a0myeloma) or <strong>paraprotein<\/strong>.<\/li><li>Levels of protein M can be measured:<ul><li>From the blood (electrophoresis)<ul><li>&#8220;M spike&#8221; is seen indicating a high level of immunoglobulins<\/li><\/ul><\/li><\/ul><ul><li>From the urine (in glomerular damage)<\/li><\/ul><\/li><li>2nd-most common group of hematological malignancy.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Multiple myeloma<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">Multiple myeloma is a clonic proliferation of plasma cells in the <strong>bone marrow<\/strong>. The cells are producing monoclonal antibodies, typically of IgG type.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Multiple<\/strong> = as it frequently\u00a0appears as multiple\u00a0patches or areas in the bone marrow; <strong>myeloma<\/strong> = swelling within the bone marrow.<\/li><li>The malignant cells are mature plasma cells that went through class switching and somatic hypermutation; they stay within the bone marrow and accumulate further mutations.<\/li><li>The plasma cells secrete monoclonal antibodies, leading to a loss of diversity of the circulating antibodies and an increased risk of infections.<\/li><li>They also <strong>stimulate osteoclast activity<\/strong> by expressing RANKL, leading to lytic bone lesions.<\/li><li>Most common chromosomal abnormalities:<ul><li><strong>Hyperpleuidity:<\/strong> good prognosis<\/li><li><strong>del(13), t(11;14) and t(6;14):<\/strong> normal prognosis<\/li><li><strong>t(4;14), and t(14;14):<\/strong> bad prognosis<\/li><\/ul><\/li><li>Most frequent primary bone tumor.<\/li><li>Most commonly affects young adults, and is more common in Blacks.<\/li><li>Presents with CRAB:<ul><li>Hyper<strong>c<\/strong>alcemia<\/li><li><strong>R<\/strong>enal insufficiency<\/li><li><strong>A<\/strong>nemia<\/li><li><strong>B<\/strong>one lesions<\/li><\/ul><\/li><li><strong>Amyloidosis<\/strong> may develop (AL-amyloidosis) presenting with macroglossia.<\/li><li><strong>Smoldering myeloma<\/strong> is essentially asymptomatic myeloma; laboratory findings suggesting MM but without any organ or tissue damage. There&#8217;s a 10% chance of it becoming symptomatic.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Clinical presentation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Bone pain and fractures<ul><li>Lytic bone lesions; seen on x-ray as &#8220;punched out&#8221; lesions<\/li><li>Due to osteoclast activation (mentioned above)<\/li><li>Can lead to hypercalcemia<\/li><li>Most commonly seen in the vertebrae, ribs, and skull<\/li><\/ul><\/li><li>Anemia<\/li><li>Recurrent infections<\/li><li>Renal insufficiency<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>CBC (demonstrating anemia)<\/li><li>ESR (>100mm\/hr; patients presenting with such ESR + bone pain are classical cases of MM)<\/li><li>Plasma (<strong>SPEP<\/strong>) and urine (<strong>UPEP<\/strong>) electrophoresis (demonstrating M-protein; in the urine, it is referred to as <strong>Bence-Jones protein<\/strong>)<\/li><li>Serum beta2-microglobulin (elevated; negative prognostic sign), albumin (reduced), and LDH (elevated)<\/li><li>Blood smear (<strong>Rouleaux formation<\/strong> &#8211; clumping of RBCs)<\/li><li>Free light-chain essay<\/li><li>Bone marrow sample (demonstrating increased clonal plasma cell population)<\/li><li>Imaging (x-ray, MRI)<\/li><li>Kidney function tests<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Prognosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\"><strong>R-ISS<\/strong> is the revised international scoring system with 3 stages, based on the levels of beta2-microglobulin (higher = worse prognosis), albumin, and LDH levels.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>Specific:<ul><li>Intensive (if &lt;70 and without comorbidities)<ul><li>4-6 induction cycles including:<ul><li>Protease inhibitor (bortezomib)<\/li><li>Corticosteroid<\/li><li>Immunomodulatory drugs (lenalidomide\/thalinomide) or cyclophosphamide<\/li><\/ul><\/li><li>Maintenance: lenalidomide, bortezomib\/ixazomib<\/li><li>Stem cell transplantation<\/li><\/ul><\/li><li>Non-intensive<ul><li>Alkylating agent (melphalan), and thalinomide or bortezomib<\/li><\/ul><\/li><\/ul><\/li><li>Supportive:<ul><li>Blood transfusion<\/li><li>Antibiotics<\/li><li>Dialysis<\/li><li>Bisphosphonates and treatment of the lytic bone lesion<\/li><\/ul><\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Background<\/h3><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Multiple myeloma<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Clinical presentation<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Prognosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Background These plasma cells are usually monoclonal and therefore produce monoclonal immunoglobulin referred to as protein M\u00a0(M\u00a0as in\u00a0myeloma) or paraprotein. Levels of protein M can be measured: From the blood (electrophoresis) &#8220;M spike&#8221; is seen indicating a high level of immunoglobulins From the urine (in glomerular damage) 2nd-most common group of hematological malignancy. Multiple myeloma [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":5539,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5355","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Multiple myeloma &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/plasma-cell-disorders-dyscrasias\/multiple-myeloma\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/plasma-cell-disorders-dyscrasias\\\/multiple-myeloma\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/plasma-cell-disorders-dyscrasias\\\/multiple-myeloma\\\/\",\"name\":\"Multiple myeloma &#8211; Meddists\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/#website\"},\"datePublished\":\"2021-05-15T21:53:42+00:00\",\"dateModified\":\"2021-05-19T17:44:09+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/plasma-cell-disorders-dyscrasias\\\/multiple-myeloma\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/plasma-cell-disorders-dyscrasias\\\/multiple-myeloma\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/plasma-cell-disorders-dyscrasias\\\/multiple-myeloma\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\\\/\\\/meddists.com\\\/learn\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Clinical\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Internal medicine\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Hematology\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/\"},{\"@type\":\"ListItem\",\"position\":5,\"name\":\"Oncological disorders\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/\"},{\"@type\":\"ListItem\",\"position\":6,\"name\":\"Plasma cell disorders (dyscrasias)\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/plasma-cell-disorders-dyscrasias\\\/\"},{\"@type\":\"ListItem\",\"position\":7,\"name\":\"Multiple myeloma\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/#website\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/\",\"name\":\"Meddists\",\"description\":\"Let&#039;s Get Studying\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/meddists.com\\\/learn\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Multiple myeloma &#8211; Meddists","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/plasma-cell-disorders-dyscrasias\/multiple-myeloma\/","twitter_misc":{"Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/plasma-cell-disorders-dyscrasias\/multiple-myeloma\/","url":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/plasma-cell-disorders-dyscrasias\/multiple-myeloma\/","name":"Multiple myeloma &#8211; Meddists","isPartOf":{"@id":"https:\/\/meddists.com\/learn\/#website"},"datePublished":"2021-05-15T21:53:42+00:00","dateModified":"2021-05-19T17:44:09+00:00","breadcrumb":{"@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/plasma-cell-disorders-dyscrasias\/multiple-myeloma\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/plasma-cell-disorders-dyscrasias\/multiple-myeloma\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/plasma-cell-disorders-dyscrasias\/multiple-myeloma\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/meddists.com\/learn\/"},{"@type":"ListItem","position":2,"name":"Clinical","item":"https:\/\/meddists.com\/learn\/clinical\/"},{"@type":"ListItem","position":3,"name":"Internal medicine","item":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/"},{"@type":"ListItem","position":4,"name":"Hematology","item":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/"},{"@type":"ListItem","position":5,"name":"Oncological disorders","item":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/"},{"@type":"ListItem","position":6,"name":"Plasma cell disorders (dyscrasias)","item":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/plasma-cell-disorders-dyscrasias\/"},{"@type":"ListItem","position":7,"name":"Multiple myeloma"}]},{"@type":"WebSite","@id":"https:\/\/meddists.com\/learn\/#website","url":"https:\/\/meddists.com\/learn\/","name":"Meddists","description":"Let&#039;s Get Studying","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/meddists.com\/learn\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/5355","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/comments?post=5355"}],"version-history":[{"count":15,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/5355\/revisions"}],"predecessor-version":[{"id":5562,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/5355\/revisions\/5562"}],"up":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/5539"}],"wp:attachment":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/media?parent=5355"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}