Multiple Myeloma

Multiple Myeloma



Jennifer K. Simpson



DEFINITION


Multiple myeloma is a cancer that belongs to a group of B-cell disorders, specifically a cancer of the plasma cell. It is characterized by an excess of abnormal plasma cells in the bone marrow and an increased production of monoclonal immunoglobulin (IgG, IgA, IgD, IgG) or Bence-Jones protein (free monoclonal κ or λ light chains).



INCIDENCE




• Accounts for 1% of all cancers and 14% of hematological malignancies (second most prevalent hematological cancer after non-Hodgkin lymphoma)


• In 2007, it is expected that 19,900 new cases of multiple myeloma will be diagnosed in 10,960 men and in 8,940 women.


• Death is expected from multiple myeloma in 10,790 (5,550 men and 5,240 women) in 2007.


• The 5-year relative survival rate for multiple myeloma is approximately 32%.



ETIOLOGY AND RISK FACTORS




• Age


˚ >65 years

˚ Median age at diagnosis is 65 years

˚ 2% are <40 years old

• Race


˚ Highest incidence: African Americans and native Pacific Islanders

˚ Lowest incidence: Asians

˚ African Americans more than twice as likely than white Americans to be diagnosed with multiple myeloma

• Family history


˚ Fourfold risk if sibling or parent has disease

• Obesity


• Other plasma cell diseases


˚ Monoclonal gammopathy of undetermined significance

˚ Olitary plasmacytoma

• Etiology is unknown


˚ Herbicides, insecticides, petroleum products, heavy metals, plastics, and asbestos may increase the risk of multiple myeloma.

• Radiation exposure victims (e.g., survivors of atomic bomb explosions in Japan) have an increased risk, although this number is small.



SIGNS AND SYMPTOMS




• Typically no symptoms in early stages


• Pain is a common early symptom as a result of osteoporosis and fractures, usually in the lower back and ribs. Other sites of osteoporosis include the pelvis and skull.


• Fatigue from anemia


• Recurrent infection, particularly pneumonia.


• Hypercalcemia


• Renal damage and potential renal failure



DIAGNOSTIC WORKUP




• Diagnosis requires presence of one major and one minor criteria or three minor criteria with multiple myeloma symptoms.


˚ Major criteria

image Biopsy-proven plasmocytoma

image Elevated monoclonal immunoglobulin levels in the serum or urine

image 30% or greater plasma cells on a bone marrow examination

˚ Minor criteria

image 10%-30% plasma cells on a bone marrow examination

image Minor monoclonal immunoglobulin levels in the serum or urine

image Lytic bone lesions or generalized osteoporosis

image Abnormally low serum antibody levels (excluding antibodies produced by myeloma cells)

• The foundation of the diagnostic workup includes a thorough history and physical examination in conjunction with laboratory tests as outlined below.



Laboratory Tests




• Complete blood cell count with differential


• Serum chemistries (calcium, albumin, lactate dehydrogenase, uric acid)


• Renal function (serum blood urea nitrogen, creatinine)


• 24-hour urine and urine protein electrophoresis to determine protein and creatinine clearance


• Serum beta2-microglobulin (reflects tumor mass)


• Serum protein electrophoresis to identify M spike


• Quantitative immunoglobulins to determine concentration of the various immunoglobulin subtypes


• Bone marrow aspirate and biopsy

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Mar 1, 2017 | Posted by in NURSING | Comments Off on Multiple Myeloma

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