Plasma Cell Myeloma (Multiple Myeloma) - Pathophysiology 370
Which type of people does PCM affect exclusively? and what age?
adults > 40 years old
What is the median age at presentation for PCM?
> 65 years old
What is PCM described as?
Malignant disorder of mature, antibody-secreting B lymphocytes (aka plasma cells)
What do malignant plasma cells invade and what do they do?
Invade the bone and form multiple tumor sites
What other tissues may malignant plasma cells target?
What abnormalities are commonly found in PCM?
chromosome structure and number
What kind of clone do malignant plasma cells belong to?
What do single clones produce? and where do they accumulate?
excessive amounts of identical monoclonal antibodies that accumulate in the blood
What can detect the monoclonal antibodies?
serum protein electrophoresis
How do Bence Jones protein form? and where do they accumulate?
malignant plasm cells produce light chain antibody fragments that accumulate in the blood and urine
What does a large amount of one type of antibody form in PCM?
a characteristic spike
What does Bence Jones help to confirm?
diagnosis for PCM
What happens when Bence Jones protein accumulates in the kidneys?
it causes damage to the kidneys
Where do malignant plasma cells tend to accumulate? and what do they produce?
in the bone and produce bone lesions
Are pathologic fractures common in PCM?
What are most clinical manifestations of PCM caused by?
bone and renal damage
What is the diagnosis of PCM based off?
monoclonal antibody peak
Bence Jones protein
Evidence of bone lesions
What is the minimum percentage range of plasma cells that need to be found in the bone marrow to confirm diagnosis of PCM?
10% to 15%
What is the percentage range that plasma cells occupy in the bone marrow?
30% to 95%
What is the onset for PCM?
slow and insidious
What is monoclonal gammopathy of undetermined significance?
malignant gammopathy of undetermined significance
a premalignant stage in some people with excess production of monoclonal antibodies but no bone lesions or Bence Jones protein in the urine
At MGUS stage, what percentage of people progress to a malignant disorder?
Do people at the MGUS stage remain symptomatic or asymptomatic?
How long can people at the MGUS stage remain asymptomatic? And how many years?
until the disease is fairly advanced and for many years
What needs to be found in the asymptomatic stage on a routine exam to diagnose PCM?
protein in urine
high serum calcium levels
What is the first symptom of PCM?
What are the bone depression indicators of PCM?
What is the percentage of patients with renal insufficiency in PCM?
What combination of factors lead to renal insufficiency?
Bence Jones protein
culminates with end-stage renal disease
What is found on a bone x-ray to confirm diagnosis of PCM? And where in the body can they be seen?
a honey comb appearance in the pelvis, ribs, spine and skull
What kind of trauma can cause fractures?
What are the type of fractures with an unknown cause called that can be occur in PCM?
How do antineoplastic agents treat PCM?
induce and maintain remission in plasma and proliferation
What is the best chemotherapy treatment for PCM?
It has not been determined yet
What kind of treatment for PCM is becoming more common?
high dose chemotherapy followed by allogenic bone marrow transplant
What is the optimal initial treatment for PCM?
Autologous stem cell transplant
What treatment is used for renal disfunction in PCM?
What are the multiple remedies used to treat chronic bone pain in PCM?
narcotic and nonnarcotic pain relievers
localized application of radiation to bone lesions
Which gender does PCM occur in most?
men > women