12/28/2023 0 Comments Raindrop treatment![]() Most common cause of renal failure in multiple myelomaĭirect nephrotoxicity of Bence Jones proteins on the epithelial cells of the renal tubules Obstructive casts form in the renal tubules composed of Bence Jones proteins, immunoglobulins, albumin and Tamm-Horsfall proteins Renal involvement is common and renal failure is multifactorial: Multiple myeloma results from monoclonal proliferation of malignant plasma cells which produce immunoglobulins (commonly IgG) and infiltrate haemopoietic locations (i.e. The most popular staging system, the International Staging System, uses the combination of β2-microglobulin test and serum albumin 6.Īpproximately 1% of cases will have negative serum electrophoresis and negative urine Bence Jones protein. Monoclonal gammopathy (IgA and/or IgG peak)īence Jones protein (Ig light chain) proteinuriaĭecreased or normal alkaline phosphatase (ALP) unless there is a pathological fracture due to impaired osteoblastic function The initial presentation occasionally is a polyneuropathy when it is part of POEMS syndrome (mostly the sclerotic form). Plasmacytomas typically progress to multiple myeloma Presentation may also be with a complication, including: The typical features can be recalled with the mnemonic CRAB 12. Worse with activity/weight-bearing, and thus is worse during the day Initially intermittent, but becomes constant Clinical presentationĬlinical presentation of patients with multiple myeloma is varied, and includes 1,2,7: Multiple myeloma and osteosarcoma combined account for ~50% of all primary bone malignancies 7. Black populations are affected at nearly twice the rate as White populations 14. ![]() It accounts for 1% of all malignancies and 10-15% of all hematological neoplasms 12,14. Multiple myeloma is a common malignancy in patients above 40 70% of cases are diagnosed between ages 50 and 70 with a median age of diagnosis being 70 years there is a male predilection (M: F 2:1) 7,12,14. Renal insufficiency: creatinine clearance 177 μmol/L (>2 mg/dL)Īnemia: hemoglobin value of >20 g/L below the lower limit of normal, or a hemoglobin value 1 focal lesions on MRI studies Hypercalcemia: serum calcium >0.25 mmol/L (>1 mg/dL) higher than the upper limit of normal or >2.75 mmol/L (>11 mg/dL) ![]() Plasmacytoma and any one or more of the following myeloma defining events:Įvidence of end-organ damage that can be attributed to the underlying plasma cell proliferative disorder, specifically: International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma has following definition for multiple myeloma 15:Ĭlonal bone marrow plasma cells ≥10% or biopsy-proven bony or extramedullary Patients are asymptomatic, with worse biochemistry than MGUS but without the end-organ damage of active multiple myeloma 9. Smoldering multiple myeloma refers to a form that falls on the spectrum between monoclonal gammopathy of unknown significance (MGUS) and active multiple myeloma. Please refer to the article plasmacytoma for discussion of the latter. The remainder of this article relates to the disseminated forms. Solitary plasmacytoma: a single large/expansile lesion most commonly in a vertebral body or in the pelvis Historically, it was sometimes known as Kahler disease or myelomatosis 13.ĭisseminated form: multiple well-defined "punched out" lytic lesions: predominantly affecting the axial skeletonĭisseminated form: diffuse skeletal osteopenia As per the WHO classification of tumors of hematopoietic and lymphoid tissues, multiple myeloma is called plasma cell myeloma 14.
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