Around 86,000 cases of multiple myeloma occur annually making this disease much less frequent cancer among both sexes compared to all other cancers.1 Typically 63,000 deaths occur each year due to multiple myeloma, accounting for 0.9% of all cancer deaths. Multiple myeloma frequency is sporadic throughout the world with highest incidenct in regions of Australia, Europe, and North America. Incidence is stable in Asian countries and has slowly increased among whites in western countries over that past few decades.
Etiology:
The etiology of multiple myeloma is not well understood.1 However, it is believed that obesity increase the risk and high fruit decreases the risk of multiple myeloma. HIV and hepatitis C also increase the risk of multiple myeloma.
Signs & Symptoms:
Typical signs and symptoms of multiple myeloma include bone pain, bleeding, anemia, fatigue, thrombocytopenia, granulocytopenia, hypercalcemia, and infection.2
Diagnostic Procedures:
In order to determine if there are any lytic lesions, an x-ray, magnetic resonance imaging (MRI), and computed tomography (CT) scan are all completed. There is also the use for a bone marrow biopsy in order to detect the amount of bone marrow taken by plasma cells.3
Histology:
Distinctive histology4
round plasma cells with an eccentric nucleus, prominent nucleolus, and clock face organization of chromatin
characteristic clear area (Hoffa clear zone) next to the nucleus represents the prominent Golgi apparatus involved in immunoglobulin (protein) production
Bone marrow aspirate
percentage of plasma cells on bone marrow aspirate is one major criteria used to distinguish plasmacytoma (10-30% plasma cells) vs. multiple myeloma (>30% plasma cells)
normal amount of plasma cells on bone marrow aspirate is < 2%
Immunohistochemical stains
CD38+
Lymph node drainage:
Cervical lymph node metastases follow the same pattern of spread as squamous cell carcinoma, incidence is 12-26%.4 The tumor usually manifests in the neck with enlarged cervical nodes.
Metastatic spread:
The tumor is generally restricted to the bone marrow.5
Grading:
Multiple myeloma is primarily categorized according to stages today. The first histological classification and staging of multiple myeloma classified multiple myeloma into 3 prognostic grades6: 1. Low grade:
Marschalko type
Small cell type
2. Intermediate grade:
Cleaved type
Polymorphous type
Asynchronous type
3. High grade:
Blastic type
Staging:
The Durie-Salmon Staging is used for multiple myeloma cases7
Stage 1: All of the following: hemoglobin >10g/dL, serum calcium normal (<12mg/dL), on roetgenogram, normal bone structure or solitary bone plasmacytoma only, low M-component production rates, lgG< 5 g/dL, lgA < 3 g/dL, urine light chain M-component on electrophoresis < 4 g/24h
Stage 2: Overall data as minimally abnormal as shown for Stage 1 and no single value as abnormal as defined for stage III.
Stage 3: One or more of the following: hemoglobin <8.5g/dL, serum calcium >12 mg/dL, advanced lytic bone lesions, high M component productions rates, lgG> 7 g/dL, lgA>5g/dL, urine light chain M component on electrophoresis > 12 g/24 hr
Radiation side effects:
Fatigue, loss of appetite, tender or red skin at treatment site, peripheral neuropathy, diarrhea, fibrosis, growth problems8
Prognosis:
Stage I 62 months
Stage II 44 months
Stage III 29 months9
Treatments:
- Chemotherapy Thalidomide Lenalidomide - Stem cell transplantation - Radiation therapy A dose of up to 15 Gy is given for most palliative cases depending on patients performance status and general condition.9
TD 5/5:
The TD 5/5 for multiple myeloma is hard to define, considering it could be anywhere in the body. Also, the dose in many patients is only 30 Gy.8 Therefore, many of the organs in the body will not come near meeting there TD 5/5 dose.
Additional images:
Reprinted from The Myeloma Foundation of Australia Inc, 2013.10
References:
Becker N. Epidemiology of multiple myeloma. US National Library of Medicine. 2011. 183:25-35. PMID: 21509679 Accessed July 12, 2013.
Chao KS, Perez CA, Brady LW. Radiation Oncology Management Decisions. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.
Schluterman KO, Fassas AB, Van Hemert RL, Harik SI. Multiple myeloma invasion of the central nervous system. Arch Neurol. 2004;61(9):1423-1429.
Bartl R, Frisch B, Fateh-Moghadam A, Kettner G, Jaeger K, Sommerfeld W. Histologic classification and staging of multiple myeloma: A retrospective and prospective study of 674 cases. Am J Clin Pathol. 1987;87(3):342-355.
Multiple myeloma frequency is sporadic throughout the world with highest incidenct in regions of Australia, Europe, and North America. Incidence is stable in Asian countries and has slowly increased among whites in western countries over that past few decades.
1. Low grade:
- Marschalko type
- Small cell type
2. Intermediate grade:- Cleaved type
- Polymorphous type
- Asynchronous type
3. High grade:Stage 1: All of the following: hemoglobin >10g/dL, serum calcium normal (<12mg/dL), on roetgenogram, normal bone structure or solitary bone plasmacytoma only, low M-component production rates, lgG< 5 g/dL, lgA < 3 g/dL, urine light chain M-component on electrophoresis < 4 g/24h
Stage 2: Overall data as minimally abnormal as shown for Stage 1 and no single value as abnormal as defined for stage III.
Stage 3: One or more of the following: hemoglobin <8.5g/dL, serum calcium >12 mg/dL, advanced lytic bone lesions, high M component productions rates, lgG> 7 g/dL, lgA>5g/dL, urine light chain M component on electrophoresis > 12 g/24 hr
Thalidomide
Lenalidomide
- Stem cell transplantation
- Radiation therapy
A dose of up to 15 Gy is given for most palliative cases depending on patients performance status and general condition.9
Reprinted from The Myeloma Foundation of Australia Inc, 2013.10
Back to Week 7