Multiple Myeloma Diagnosis and Treatment

 

Multiple Myeloma-is a malignant B-cell lympho prolipherative disorder, characterized by the abnormal proliferation of plasma cells in the bone marrow.it is also called plasma cell tumour. Multiple Myeloma accounts for about 1% of all malignant diseases and 10% of all hematologic cancers. Multiple myeloma commonly affects older adults, but it can occur in younger individuals also. In this article we describe multiple myeloma diagnosis and treatment including clinical features, x-ray and lab findings, pathology and pathogenesis, differential diagnosis, treatment plan and treatment guideline also.

 

Clinical Features

Age-45-65 years,

Site- any bone may involve- Vertebra,skull,hip,long bones, ribs .

Weakness,

Backache,

Bone pain,

Pathological fracture,

Thirst, poly urea, abdominal pain,-Due to hypercalceamia.

Localized tenderness,

Restricted movement when near the joint.

Signs of cord compression,

Root compression, (vertebral collapse).

Recurrent infection,

Chronic nephritis.

Pathogenicity:

Plasma cell Predominating--Marrow cell prolipheration-

Increased osteoclastic activity-

Osteoporosis and discrete Lytic lesions throughout the skeleton.

Association with increased blood viscosity and aneamia

Hypercalcemia, renal dysfunction

A large colony of plasma cells may form-

Sooner or later it may become a wide spread disease.

X-ray Findings-

Only may generalized osteoporosis.

Vertebral compression,

Multiple punched out defects with soft margin in site affected.

 

Multiple Myeloma diagnosis blood test

Hb% - decrease ,

ESR, Serum Creatinine, Serum calcium- Raised,

Protein electrophoresis-abnormal band

Others Lab Findings-

Urine Examination – Presence of Bence Jones protein

Bone Marrow study- Plasmacytosis with typical 'myeloma' cells

Pathology-

Macroscopic- Affected bone soft and crumbly.

Microspic- Sheets of plasmacytes with large eccentric neucleus containing spoke like arrangement of chromatin

Differential Diagnosis-

Osteoporosis,

Cystic bone lesion,

Metaststic  bone disease, 

Paraprotenaemia/Gammopathies

 

TREATMENT-

Multiple myeloma treatment guidelines-

General Measure-

Control of Pain,

Control of infection -antibiotics

Correction of fluid imbalance

Correction of hypercalcemia

Take measures for Pathological fracture-

Specific therapy for Multiple myeloma

Treatment for solitary lesion

 

Pathological fracture-

Fracture in Limb- Internal fixation and cavity filled with bone cement,

Spinal fracture- needs stabilization with fixation or braching,

Root compression- needs decompression.

Solitary lesion- Radiotherapy,

Specific therapy- 

Alkylating cytotoxic agent- (Malphalan),  Corticosteroid for pain

Prognosis-

Poor, Median survival Rate  – 2 years to 5 years.

 

Multiple Myeloma Treatment Options-

Therapeutic procedure includes  a broad spectrum, as  chemotherapy, immunotherapeutic agents, proteasome inhibitors, corticosteroids, targeted therapies, and stem cell transplantation also. As well as  improvement of  supportive measures, like  bisphosphonates and monoclonal antibodies, have better outcomes and improve quality of life for patients with multiple myeloma.

Multiple myeloma treatment center-

MD Anderson Cancer Center - Houston, Texas, USA

Mayo Clinic - Rochester, Minnesota, USA

Dana-Farber Cancer Institute - Boston, Massachusetts, USA

John Theurer Cancer Center at Hackensack University Medical Center - Hackensack, New Jersey, USA

Memorial Sloan Kettering Cancer Center - New York City, New York, USA

University of Arkansas for Medical Sciences (UAMS) Myeloma Institute - Little Rock, Arkansas, USA

University College London Hospitals (UCLH) - London, United Kingdom

All India Institute of Medical Sciences (AIIMS)

Tata Memorial Hospital - Mumbai, Maharashtra:

Kidwai Memorial Institute of Oncology - Bengaluru, Karnataka

Christian Medical College (CMC) - Vellore, Tamil Nadu:

Apollo Hospitals - Various locations across India

Bangladesh Cancer Society – Dhaka

National Institute of Cancer Research and Hospital (NICRH) – Dhaka

United Hospital - Dhaka

Apollo Hospitals Dhaka – Dhaka

 

Though much and more improvement in the treatment of multiple myeloma, There are some challenges till persist, Specially recurrence of disease, treatment failure, and complications also. Further research activities should be carried out for proper evaluation of the pathophysiology of the disease and select better therapeutic agents, fostering hope for improvement in diagnosis and treatment of this type of disease   to enhance the  prognosis for patients affected by multiple myeloma as this is a complex hematological malignant disorder.