Multiple myeloma hematology and oncology msd manual. There are three major forms of renal damage in patients with multiple myeloma. Lymphocytes lymph cells are one of the main types of white blood cells in the immune. Multiple myeloma mm is the most frequent cancer to involve the skeleton with 8090% of patients developing bone lesions during their disease course. Aug 10, 2014 pathophysiology of myeloma bone disease. After a median followup of 58 months, 67% of patients will develop progression to multiple myeloma. Myeloma bone lesions are purely osteolytic and are associated with severe and debilitating bone pain, pathologic fractures, hypercalcemia, and spinal cord compression, as well as increased mortality. Herein, we provide an insight into the underlying pathogenesis of bone disease and discuss possible directions for future studies. Jul 06, 2016 jatin shah, md, explains that there is no clear reason for why patients develop multiple myeloma, and so theres no clear risk factor. The imfs patient handbook is designed to help you to understand multiple myeloma which we refer to simply as myeloma. The importance of specialized pathology our team of hematology pathologists focuses exclusively on the diagnosis of blood cancers, including multiple myeloma. Multiple myeloma mm is a plasma cell malignancy characterized by a high capacity to induce osteolytic bone lesions. Multiple myeloma mm, also known as plasma cell myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies. Plasma cells come from b lymphocytes, and produce antibodies immunoglobulins.
The reported frequency of kidney impairment in multiple myeloma varies depending upon the definition used. A cancerous or malignant plasma cell is called a myeloma cell. Multiple myeloma is a malignant disorder characterized by the proliferation of plasma cells. Multiple myeloma mm is a fatal, malignant bcell neoplasm characterized by uncontrolled, destructive growth of mutated plasma cells within the bone marrow. Plasma cells help you fight infections by making antibodies that recognize and attack germs. Myeloma is called multiple because there are frequently multiple. Complications may include amyloidosis the cause of multiple myeloma is unknown. Monitor for multiple myeloma symptoms and m protein serum and urine every six to 12 months. Bone disease and renal failure are the main cause of morbidity. First described in 1848, mm is characterized by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein m protein. Kidney disease is a common complication of monoclonal gammopathies including multiple myeloma. Multiple myeloma mm is an agedependent monoclonal tumor of bm plasma cells pcs. This activity is accompanied by suppressed osteoblast differentiation and activity, resulting in severely impaired bone formation and development. Diagnosis typically requires demonstration of mprotein.
These cells are part of your immune system, which helps protect the body from germs and other harmful substances. Mm patients develop osteolytic bone lesions that can cause pathologic fractures and. Plasma cells make antibodies against infectious agents such as viruses and bacteria. If the pathology is wrong, everything that follows will likely be incorrect as well. In contrast to normal bone remodeling, the coupling mechanism of ocs and obs is lost in mm. Multiple myeloma always develops from mgus monoclonal gammopathy of undetermined significance. May be primary plasma cell leukemia feb 27, 2019 multiple myeloma is a form of cancer that affects bone marrow, the spongy soft tissue that lies within the hollow centre of some bones.
Multiple myeloma causes cancer cells to accumulate in the bone marrow, where they crowd out healthy blood cells. Pathophysiology and diagnosis of multiple myeloma youtube. Serum protein electrophoresis spep is a test that measures the antibodies in the blood and can find a monoclonal antibody. Wm cells have features of both plasma cells and lymphocytes. Patients endure severe bone pain, pathologic fractures, hypercalcemia, and a markedly decreased quality of life. Multiple myeloma mm, also known as plasma cell myeloma and simple myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies. Multiple myeloma is a cancer of the bone marrow plasma cells. The multiple myeloma induced bone destruction is a result of the increased activity of osteoclasts that occurs adjacent to multiple myeloma cells.
Some early cancers may have signs and symptoms that can be noticed, but that is not always the case. Apr 23, 2020 multiple myeloma, also called plasma cell myeloma or myelomatosis, malignant proliferation of cells within the bone marrow that usually occurs during middle age or later and increases in occurrence with age. The understanding of these pathways is closely linked to their therapeutic implications and is stressed upon in the initial chapters. Multiple myeloma in the bone marrow disrupts the production of these new blood cells. As a result, myeloma patients may develop anemia low red blood cell count with susceptibility to infection, low white blood cell count neutropenia, andor low platelet count thrombocytopenia with an increased bleeding tendency. Abnormal antibody fragments are produced in multiple myeloma and are deposited in various organs, such as the kidneys.
Recently, the introduction of newer agents such as. This activity is accompanied by suppressed osteoblast differentiation and activity, resulting in severely impaired bone formation and development of devastating osteolytic lesions. Multiple myeloma mm is a debilitating malignancy that is part of a spectrum of diseases ranging from monoclonal gammopathy of unknown significance mgus to plasma cell leukemia. Endorgan damage to the kidneys is typically due to light chain cast nephropathy. The risk that mgus progresses into malignant disease is about 1% annually.
Multiple myeloma, the most common bone malignancy, is occurring with increasing. Multiple myeloma myeloma multiple myeloma symptoms. A wide range of renal manifestations and pathologies involving different mechanisms have been described with these disorders. The symptoms of multiple myeloma are not usually evident in the early stages of disease, which is often only detected or diagnosed as.
Oslo university hospital shall not be liable for any loss whether direct, indirect, incidental or consequential, arising out of access to, use of, or reliance upon any of the. Pathophysiology the pathological and clinical features of myeloma are due to. Multiple myeloma is the second most common type of blood cancer after leukemia. Multiple myeloma dr harpreet singh bhatia dmch, ludhiana,punjab 2. Electrophoresis the antibody produced by myeloma cells is abnormal because it is monoclonal all the exact same.
Common manifestations include lytic lesions in bones causing pain, andor fractures, renal insufficiency, hypercalcemia, anemia, and. Multiple myeloma is a type of cancer that affects plasma cells. Jatin shah, md, explains that there is no clear reason for why patients develop multiple myeloma, and so theres no clear risk factor. Criteria for the classification monoclonal gammopathies, multiple myeloma and related disorders. Multiple myeloma is considered a cancer of plasma cells, and nonhodgkin lymphoma is a cancer of lymphocytes. Feb 27, 2019 the symptoms of multiple myeloma are not usually evident in the early stages of disease, which is often only detected or diagnosed as a result of routine blood and urine tests. Pdf multiple myeloma is divided into two distinct genetic subtypes based on chromosome content. Myeloma is a cancer of the plasma cells in the bone marrow. Multiple myeloma is a cancer of plasma cells that produce monoclonal immunoglobulin and invade and destroy adjacent bone tissue. Pathophysiology and diagnosis of multiple myeloma jatin shah, md, explains that there is no clear reason for why patients develop multiple myeloma, and so theres no clear risk factor. Myelomas are slightly more common in males than in females and can affect any of the marrowcontaining bones, such as the skull, the flat. Recently the biologic mechanism involved in the imbalance between osteoclast activation and osteoblast inhibition induced by multiple myeloma cells has begun to be clarified.
However, the natural history of plasmacytoma is such that there is a risk of progression to active multiple myeloma after many years. Multiple myeloma is a cancer that begins in plasma cells, a type of white blood cell. More than 80% of mm patients suffer from destructive bony. Myeloma is called multiple because it frequently involves multiple areas in the body. The bone marrow contains stem cells that produce three types. We hope that the information will be helpful to both healthcare professionals and patients. Plasma cells are a type of white blood cell found in bone marrow, which is the soft tissue inside most of your bones that produces. Multiple myeloma early detection, diagnosis, and staging 1. Increased osteoclastic activity resulting in bone resorption and suppressed osteoblastic activity leading to decreasedabsent bone formation are key factors in the development of mbd18 fig. Multiple myeloma, malignant proliferation of cells within the bone marrow that usually occurs during middle age or later and increases in occurrence with age. Pathology outlines plasma cell myeloma multiple myeloma. Malignanat b cell lymphoproliferative disorder of the marrow with plasma cell predominating.
In most cases, a diagnosis of plasmacytoma is not concurrent with a diagnosis of multiple myeloma. The patient handbook focuses on the questions and decisions that a newly diagnosed patient faces. Multiple myeloma early detection, diagnosis, and staging. What is multiple myeloma definition, answers and support. In multiple myeloma, the level of one type may be high while the others are low. Common manifestations include lytic lesions in bones causing pain, andor fractures, renal insufficiency, hypercalcemia, anemia, and recurrent infections. Pdf myeloma bone disease mbd is a devastating complication of multiple myeloma mm.
The immune system is made up of several types of cells that work together to fight infections and other diseases. Understanding the pathogenesis of myeloma bone disease has allowed us to identify novel targets for treating the disease. Myeloma causes structural bone damage, which can result in weakened bones and leads to painful fractures or bone breaks over time. As it progresses, bone pain, bleeding, frequent infections, and anemia may occur. Bone destruction in mm results from increased osteoclast formation and activity that occur in close proximity to myeloma cells. Myeloma can cause a range of symptoms because of its effect on the bones, bone marrow, blood, urine and kidneys.
Jci molecular pathogenesis of multiple myeloma and its. Multiple myeloma is a form of cancer that affects bone marrow, the spongy soft tissue that lies within the hollow centre of some bones. Abstract multiple myeloma accounts for approximately 10% of hematologic malignancies. Plasma cells are a type of white blood cell found in bone marrow, which is the soft tissue. Approximately 50 percent of patients with multiple myeloma experience acute kidney injury aki or chronic kidney disease ckd at some time during the course of their disease. Multiple myeloma mm is a plasma cell disorder, characterized by bone marrow infiltration with clonal plasma cells, production of monoclonal immunoglobulin paraprotein, and end organ damage including lytic lesions in the bones, renal impairment, hypercalcemia, and anemia. Myeloma bone disease is responsible for some of the most devastating complications of the disease. The multiple myelomainduced bone destruction is a result of the increased activity of osteoclasts that occurs adjacent to multiple myeloma cells. Bone destruction is a hallmark of multiple myeloma mm. It is synonymous with myeloma and plasma cell myeloma. However, different people with myeloma can have different symptoms, and most will only have one or two symptoms.
Pathophysiology of multiple myeloma bone disease sciencedirect. Learn more about the symptoms, causes, diagnosis, risk factors, and treatment of multiple myeloma. Wm cells make large amounts of a certain type of antibody immunoglobulin m, or igm, which is known as a macroglobulin. May be primary plasma cell leukemia myeloma or represent a late stage transformation secondary typically lack cd56, more frequent abnormal karyotype. Epidemiology and pathophysiology multiple myeloma accounts for 1. Multiple myeloma pathology roswell park comprehensive. Myeloma is usually called multiple myeloma because most people 90% or more have multiple bone lesions when diagnosed or lesions develop over the course of the illness. Much insight has been gained into the molecular pathways that lead to myeloma and indeed much more remains to be done.
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