SUNFLOWER HOSPICE Home Team

TEN MINUTE MEDICINEMultiple Myeloma

11.18.2014

Multiple Myeloma

• 2nd Most Common Cancer of the Blood

• Most Common Type of Plasma Cell Cancer

• Accounts for 1% of all Cancers

• And 2% of All Cancer Deaths

Multiple Myeloma

Pathophysiology

• B lymphocytes start in Bone Marrow move to Lymph Node

• Mature and display Different Proteins on Cell Surface

• When Activated to Secrete Antibodies they are known as Plasma Cells

• Immune system keeps Proliferation of B cells and Secretion of Ab under controll

• Production of Cytokines by Plasma Cells Cause Osteoporosis & Deposits in all Organs

4 out of 100,00 in US

• More in Developed Western Countries

• 2x more in African Americans (9.5/100,00)

• More in Offsprings & Siblings of Pt’s with M2

• Asians Lower Incidence

CRAB

• HyperCalcemia

• Renal Insufficiency

• Anemia

• Bone Leisions

Signs & Symptoms

• Bone Pain

• Anemia

• Renal Failure from Proteins Secreted

• Infection Pneumonia and Pyelonephritis due to immune deficiency

• Neurologic Symptoms, Weakness, confusion, fatigue (anemia, hypercalcemia)

• Headache Retinopathy, Incr Viscosity Blood

• Paraplegia in late cases

Diagnosis Protein ElectrophoresisIncreased Calcium

Most Common Area

Bone Pain Most Common Symptom

Punched Out or Pepper Pot

Osteolytic Leisions In 70%

Compression Fractures Pain Usually Spine & Ribs

Treatment

• Decrease Clonal Plasma Cell Population

• Therefore Decreases Sign & Sx of Disease

• Administer Bisphophonates to Prevent Fx(Pamidronate or Zoledronic Acid)

• Tx for Anemia, Transfuse

• <65yo High Dose Chemo & Stem Cell Transplant

• All Reoccur, 5-10% treatment Mortality

Prognosis

• 15% die within 3months of Diagnosis

• 60% Respond to Treatment for 2 1/2-3years

• 23% Die from other Illness Assoc with Age

• 5 year 35% Survival

Sunflower Thought

The EndWe Bloom Where We Are Planted