Classifications and external resources
Multiple myeloma (also known as MM, myeloma, plasma cell multiple myloma myeloma, or as Kahler's disease after Otto Kahler) is a type of multiple myoloma cancer of plasma cells, immune system cells in bone marrow that produce antibodies. multiplemyeloma Its prognosis, despite therapy, is generally poor, and treatment may involve chemotherapy multiple meloma and stem cell transplant. It is part of the mutiple myeloma broad group of diseases called hematological malignancies.
- 1 Clinical multiple myrloma features
- 2 Diagnosis
- 2.1 Investigations
- 2.2 Workup
- 2.3 Diagnostic multiple myaloma multple myeloma criteria
- 2.4 Staging
- 3 Pathophysiology
- 4 Epidemiology
- 5 Treatment
- 5.1 Initial miltiple myeloma therapy
- 5.2 Relapse
- 6 Prognosis
- 7 See myloma also
- 8 References
- 9 External multiple myeloma links
Because many multiple myeloma in dogs organs can be affected by myeloma, the symptoms and signs are very variable. bone cancer marrow multiple myeloma A mnemonic sometimes used to remember the common tetrad of multiple symptoms of multiple myeloma myeloma is CRAB - C = Calcium (elevated), R =Renal failure, A = Anemia, B = multiple myeloma cancer Bone multiple myeloma treatment lesions. Myeloma has many possible symptoms, and all symptoms may be due to other causes. They are presented here in multiple myeloma cancer treatment decreasing order of incidence.
- Bone pain
Myeloma bone pain usually involves multiple myeloma night sweats the spine and ribs, and worsens with activity. Persistent localized pain may indicate a pathological bone marrow cancer multiple myeloma fracture. Involvement cancer multiple myeloma of the vertebrae may lead to spinal cord compression. Myeloma bone disease is due to proliferation of tumor cells and release of IL-6, multiple myeloma causes also known as osteoclast activating factor (OAF), which stimulates osteoclasts multiple myeloma prognosis to break down bone. These multiple myeloma staging bone lesions are lytic in nature and are best seen in plain radiographs, which may show a "punched-out" resorptive lesions. The survival rate of multiple myeloma breakdown canine multiple myeloma of bone also leads to release of calcium into the blood, leading to survival rate for multiple myeloma patients hypercalcemia and its associated symptoms.
The most common infections are pneumonias and pyelonephritis. Common pneumonia pathogens include S pneumoniae, S aureus, and multiple myeloma and anion gap K pneumoniae, while common pathogens causing pyelonephritis include pictures of multiple myeloma E coli and other gram-negative organisms. The increased risk of infection is due to sarcoidosis and multiple myeloma immune deficiency resulting from diffuse hypogammaglobulinemia, which is due to decreased production and increased cancer treatment centers of america multiple myeloma destruction of normal antibodies.
- Renal failure
Renal failure death rates of multiple myeloma may develop both acutely and chronically. It is commonly due to hypercalcemia (see above). It end stage multiple myeloma may also be due to tubular damage from excretion of light chains, which can manifest late stage multiple myeloma causes as the Fanconi syndrome (type II life expectancies for multiple myeloma renal tubular acidosis). Other causes include glomerular deposition of amyloid, hyperuricemia, multiple myeloma anemia recurrent infections (pyelonephritis), and local infiltration of tumor cells.
The anemia found in myeloma multiple myeloma symptoms is usually normocytic and normochromic. It results from the stem cell multiple myeloma replacement of normal bone marrow by infiltrating tumor cells and inhibition of normal red blood cell production (hematopoiesis) by hormone therapy as a treatment for multiple myeloma cytokines.
- Neurological symptoms
Common problems are weakness, confusion and fatigue due to hormone therapy treatment multiple myeloma hypercalcemia. Headache, visual changes and retinopathy may be the result of hyperviscosity of iga kappa multiple myeloma secondary mds the blood depending on the properties of the paraprotein. Finally, there may multiple myeloma and prognosis be radicular pain, loss of bowel or bladder multiple myeloma caused hyperparathyroidism control (due to involvement of spinal cord leading to cord compression) multiple myeloma research foundation or carpal tunnel syndrome and other neuropathies (due to infiltration of peripheral nerves nursing care for multiple myeloma by amyloid). It may give rise to paraplegia smoldering multiple myeloma in late presenting cases.
The presence of unexplained anemia, kidney dysfunction, a treatment for multiple myeloma stage 3 high erythrocyte sedimentation rate (ESR) and a high serum protein (especially raised immunoglobulin) may what is multiple myeloma prompt further testing. A doctor will request protein electrophoresis of the blood and urine, which might show the disability with multiple myeloma presence of a paraprotein (monoclonal protein, or M protein) band, with or late stages multiple myeloma without reduction of the other multiple myeloma bone cancer (normal) immunoglobulins (known as immune paresis). One type multiple myeloma cancer health of paraprotein is the Bence Jones protein which is a urinary paraprotein composed of free light chains (see below). Quantitative measurements of the multiple myeloma chester paraprotein are multiple myeloma in children necessary to establish a diagnosis and to monitor the disease. The paraprotein is an abnormal multiple myeloma nanobacteria immunoglobulin produced by the tumor clone. Very rarely, the myeloma is nonsecretory (not producing immunoglobulins).
In theory, multiple myeloma can multiple myeloma protein charge produce all classes of multiple myeloma research immunoglobulin, but IgG paraproteins are most common, followed by IgA and IgM. IgD and IgE multiple myeloma survival myeloma are very rare. In addition, light and or heavy chains (the building blocks of myeloma cancer multiple myeloma death antibodies) may be secreted in isolation: κ- or λ-light chains or any of the stages of multiple myeloma five types of heavy stem cell treatment for multiple myeloma chains (α-, γ-, δ-, ε- or μ-heavy chains).
Additional findings include: a raised calcium (when osteoclasts are breaking what causes multiple myeloma down bone, releasing calcium into the bloodstream), actor has multiple myeloma raised serum creatinine due to reduced renal function, which may be due to paraprotein deposition in the kidney.
The workup cancer multiple myeloma treatment of suspected multiple myeloma includes a darren mccarty multiple myeloma cancer skeletal survey. This is a series of X-rays of the skull, axial skeleton and proximal donating blood and multiple myeloma long bones. Myeloma activity sometimes appear gonzales louisiana multiple myeloma cancer treatment as "lytic lesions" (with local disappearance of normal bone due to resorption), and on the skull X-ray as "punched-out lesions" (pepper information on multiple myeloma pot skull). Magnetic resonance imaging (MRI) is more sensitive then simple X-ray intravenous contrast and multiple myeloma in the detection of lytic lesions, and may supersede skeletal survey, especially metastatic sites for multiple myeloma when vertebral disease is suspected. Occasionally a multiple cell myeloma CT scan is performed to measure the size of soft tissue plasmacytomas.
A bone multiple myeloma alternative relapse treatment marrow biopsy is usually performed to estimate the percentage of bone marrow multiple myeloma and osteomylitis occupied by plasma cells. This percentage is used in the diagnostic criteria for myeloma. Immunohistochemistry multiple myeloma and pictures (staining particular cell types using antibodies against surface proteins) can detect plasma multiple myeloma bart barlogie cells which express immunoglobulin in the cytoplasm but usually not on the surface; multiple myeloma cause myeloma cells are typically CD56, CD138 positive and CD19 negative. Cytogenetics multiple myeloma contest may multiple myeloma diagnosis also performed in myeloma for prognostic purposes.
Other useful laboratory tests include quantitative measurement of IgA, multiple myeloma disease IgG, IgM (immunoglobulins) to look for immune paresis, and β2-microglobulin which provides prognostic information.
The recent introduction of multiple myeloma drug a commercial immunoassay multiple myeloma emedicine for measurement of free light chains potentially offers an improvement in monitoring disease progression and response to treatment, particularly where multiple myeloma hhv 8 the paraprotein is difficult to measure accurately by electrophoresis (for example in light chain multiple myeloma nutrition treatment myeloma, multiple myeloma reoccuring or where the paraprotein level is very low). Initial research also suggests that measurement of free light chains may also be used, in multiple myeloma ribbon conjunction with other markers, multiple myeloma stages for assessment of the risk of progression from monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma
In 2003, the International Myeloma Working Group agreed on diagnostic criteria multiple myeloma support group for symptomatic myeloma, asymptomatic myeloma and MGUS (monoclonal gammopathy multiple myeloma symptom of undetermined significance):
- Symptomatic myeloma:
- Clonal plasma cells >10% on bone marrow biopsy or (in any quantity) in a multiple myeloma treatment options myelodysplastic and multiple myeloma and journal biopsy from other tissues (plasmacytoma)
- A monoclonal protein (paraprotein) in either serum or urine
- Evidence of people who have been cured with multiple myeloma end-organ damage (related organ or tissue impairment, ROTI):
- Hypercalcemia (corrected calcium >2.75 mmol/L)
- Renal insufficiency picture of multiple myeloma attributable to myeloma
- Anemia (hemoglobin <10 g/dL)
- Bone lesions (lytic lesions or osteoporosis with compression fractures)
- Frequent severe infections (>2 a year)
- Amyloidosis of other prognosis multiple myeloma with secondary mds organs
- Hyperviscosity syndrome
- Asymptomatic myeloma:
- Serum paraprotein >30 g/L AND/OR
- Clonal plasma cells relapse multiple myeloma >10% on bone marrow biopsy AND
- NO myeloma-related organ or tissue impairment
- Monoclonal gammopathy of undetermined significance stage 1 multiple myeloma (MGUS):
- Serum paraprotein staging for multiple myeloma <30 g/L AND/OR
- Clonal plasma cells <10% on bone marrow biopsy AND
- NO myeloma-related organ or tissue impairment
Related conditions include thalidomide multiple myeloma solitary plasmacytoma (a single tumor of plasma cells, typically treated with irradiation), plasma cell dyscrasia (where alkaline vs acidic body and multiple myeloma only the amyloid and multiple myeloma antibodies produce symptoms, e.g. AL amyloidosis), and POEMS syndrome (peripheral neuropathy, organomegaly, cancer pins for multiple myeloma endocrinopathy, monoclonal plasma cell disorder, skin changes).
- International Staging System
The International Staging System (ISS) for cd antigens in multiple myeloma myeloma was published by the International Myeloma Working Group in 2003 :
- Stage I: β2-microglobulin (β2M) cells multiple myeloma bone plasma health webmd blood a-z < 3.5 center multiple myeloma research mg/L, albumin >= 3.5 g/dL
- Stage II: β2M < 3.5 and albumin < 3.5; or β2M between final stage of multiple myeloma 3.5 and 5.5
- Stage III: β2M > 5.5
- Durie-Salmon staging system
First published in 1975, the Durie-Salmon staging system  is hereditary multiple myeloma still in use, but has largely been superseded by the simpler ISS:
- stage 1: all of
- Hb > 10g/dL
- normal calcium
- Skeletal survey: hospital multiple myeloma normal or single plasmacytoma or osteoporosis
- Serum paraprotein hospitals dealing with multiple myeloma level < 5 g/dL if IgG, < 3 g/dL if IgA
- Urinary light chain excretion < 4 g/24h
- stage 2: fulfilling the hospitals specializing in multiple myeloma criteria of neither 1 nor 3
- stage 3: one or more hypo granular platelets in multiple myeloma of
- Hb < 8.5g/dL
- high calcium > 12mg/dL
- Skeletal survey: 3 or more lytic bone lesions
- Serum paraprotein >7g/dL image multiple myeloma if IgG, > 5 g/dL if IgA
- Urinary light chain excretion immunofixation electrophoresis multiple myeloma > 12g/24h
Stages 1, 2 and 3 of the Durie-Salmon staging system korean multiple myeloma working party can be divided into A or B depending on serum creatinine:
- A: serum creatinine multiple myeloma + longevity < 2mg/dL multiple myeloma adventure cancer theatre (< 177 umol/L)
- B: serum creatinine > 2mg/dL (> 177 umol/L)
Multiple myeloma develops in post-germinal center B lymphocytes.
A chromosomal multiple myeloma and bladder cancer translocation between the immunoglobulin heavy chain gene (on the fourteenth chromosome, locus 14q32) and an oncogene multiple myeloma apheresis (often 11q13, 4p16.3, 6p21, 16q23 and 20q11 is multiple myeloma bone marrow transplant frequently observed in patients multiple myeloma bracelet with multiple myeloma. This mutation results in dysregulation of the oncogene which is thought to be important initiating event in the multiple myeloma buy contest pathogenesis of myeloma. The result is proliferation of a plasma cell clone multiple myeloma cancer and treatment and genomic instability that leads multiple myeloma cancer dave to further mutations and translocations. The chromosome 14 abnormality multiple myeloma cancer research is observed in about 50% of all cases of myeloma. Deletion of (parts of) the thirteenth chromosome is also observed in multiple myeloma cat about 50% of multiple myeloma cells bone plasma cases.
Production of cytokines (especially IL-6) by the plasma cells causes much of multiple myeloma cure their localised damage, such as osteoporosis, and creates a microenvironment in multiple myeloma daily which the malignant cells thrive. Angiogenesis (the attraction of new blood vessels) is increased.
The produced antibodies are deposited in various organs, multiple myeloma definition leading to renal multiple myeloma dental problems failure, polyneuropathy and various other myeloma-associated symptoms.
There are approximately 45,000 people in multiple myeloma diet the United States living with multiple myeloma, and the American Cancer Society estimates that approximately 14,600 new cases of myeloma are diagnosed multiple myeloma diseases orphan each year in the United States. multiple myeloma doctor contest It follows from here that the multiple myeloma doctor free average prognosis is about three years.
Multiple myeloma is the second most multiple myeloma drug cancer cell prevalent blood cancer (10%) after non-Hodgkin's lymphoma. It represents approximately 1% of all cancers and 2% of all cancer deaths. Although the peak multiple myeloma drug midstage study age of onset of multiple myeloma is 65 to 70 multiple myeloma drugs years of age, multiple myeloma engineer free recent statistics indicate both increasing incidence and earlier age of onset.
Multiple myeloma affects slightly more men than women. multiple myeloma engineer online African Americans and Native Pacific multiple myeloma feline Islanders have the highest reported incidence of this disease and Asians the multiple myeloma final stage lowest. Results of a recent study found the incidence of myeloma to be 9.5 cases multiple myeloma foundation per 100,000 African Americans and 4.1 cases per 100,000 multiple myeloma free Caucasian Americans. Among African Americans, myeloma is one of the top 10 leading causes of cancer death.
Treatment for multiple myeloma multiple myeloma general is focused on disease containment and suppression. Although allogeneic stem cell transplant might cure multiple myeloma iii phase trial the cancer, it is considered investigational given the high treatment related multiple myeloma institute of arkansas mortality of the procedure. In addition to direct treatment of the plasma multiple myeloma integration best cell proliferation, bisphosphonates (e.g. pamidronate) are routinely administered multiple myeloma integration contest to prevent fractures and erythropoietin to treat anemia.
Initial therapy is aimed at multiple myeloma integration risk treating symptoms and reducing the burden of disease. Commonly used multiple myeloma jaw osteonecrosis induction regimens include dexamethasone with or without thalidomide, and VAD (vincristine, doxorubicin (Adriamycin), multiple myeloma light chain disease and dexamethasone). Low-dose therapy with melphalan combined with prednisone can be used multiple myeloma mortality rate to palliate symptoms in patients who cannot tolerate aggressive multiple myeloma neuropathy therapy. Plasmapheresis can be used to treat multiple myeloma online protein proliferation if the end-organ damage is severe and progressive.
In patients who have good performance status, the next step in therapy is multiple myeloma pathophysiology high-dose chemotherapy with melphalan with multiple myeloma patients evaluated survival autologous stem cell transplantation. This can be given in tandem fashion, multiple myeloma phase iii i.e. an autologous transplant followed by a second transplant. Nonmyeloablative (or "mini") allogeneic stem cell transplantation is being investigated as an multiple myeloma race for research alternative to autologous stem multiple myeloma radiology cell transplant, or as part of a tandem transplant following an autologous transplant (also known as an "auto-mini" tandem transplant).
The natural history of myeloma is of relapse following treatment. Depending multiple myeloma recurring on the patient's condition, the prior treatment multiple myeloma studies modalities used and the duration of remission, options for relapsed disease include re-treatment with the original multiple myeloma treatment centers agent, use of other agents (such as multiple myeloma treatments melphalan, cyclophosphamide, thalidomide or dexamethasone, alone or in combination), and a second autologous multiple myeloma with neuropathy stem cell transplant.
Later in the myelodysplastic and multiple myeloma and medscape course of the disease, "treatment resistance" occurs. This may be a reversible effect , and myelodysplastic and multiple myeloma and neuropathy some new treatment modalities may re-sensitize the tumor to standard therapy. For myelodysplastic and multiple myeloma and neuropathy and mds patients with relapsed disease, bortezomib (or Velcade®) is a night sweats multiple myeloma recent addition to the therapeutic arsenal, especially as second line therapy. Bortezomib is a proteasome inhibitor. Finally, lenalidomide (or Revlimid®), a less nutritional needs in patients with multiple myeloma toxic thalidomide analog, is showing promise oncologist multiple myeloma baylor for treating myeloma.
Renal failure in multiple myeloma can phase iii multiple myeloma prognoces be acute (reversible) or chronic (irreversible). Acute renal failure typically resolves when the plasma cell cancer multiple myeloma calcium and paraprotein levels are brought under control. Treatment of chronic renal failure is dependent on plasma cell multiple myeloma bone the type of renal failure plasma cells multiple myeloma bone and may involve dialysis.
The International Staging System can help to predict survival, positive multiple myeloma stories with a median survival of 62 months for stage 1 disease, 45 months for stage 2 psp/psk and multiple myeloma disease, and 29 months for stage 3 disease .
Cytogenetic analysis of myeloma cells may be secondary myelodysplastic syndrome in multiple myeloma of prognostic value, with deletion of chromosome 13, non-hyperdiploidy and the stages multiple myeloma balanced translocations t(4;14) and t(14;16) conferring statistics multiple myeloma a poorer prognosis. The 11q13 and 6p21 cytogenetic abnormalities are associated with a better prognosis.
Prognostic markers stem cell transplants for patients with multiple myeloma such as these are always generated by retrospective analyses, and symptoms multiple myeloma it is likely that new treatment treatment for multiple myeloma developments will improve the outlook for those with traditionally 'poor-risk' disease.
- Waldenström macroglobulinemia
- Multiple Myeloma velcade treatment for multiple myeloma Research Consortium
- Multiple Myeloma Research Foundation
- MM Support Network
- ^ a b c International Myeloma Working vitamin b17 and multiple myeloma Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of what are the stages of multiple myeloma the International Myeloma Working Group. Br J who classification multiple myeloma Haematol 2003;121:749-57. PMID 12780789.
- ^ a b Greipp PR, San Miguel J, Fonseca R, Avet-Loiseau H, Jacobson JL, Rasmussen E, Crowley J, Durie BMG. Development of an international prognostic index (IPI) for myeloma: report of the international myeloma working group. Hematology Journal 2003;4:S42. NLM ID 100965523.
- ^ Durie BG, Salmon SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment and survival. Cancer 1975;36:842–854. PMID 1182674.
- ^ a b c Kyle RA, Rajkumar SV. Multiple myeloma. N Engl J Med 2004;351:1860-73. PMID 15509819.
- International Myeloma Foundation
- International Myeloma Foundation (UK)
- Multiple Myeloma Research Foundation
- MM Support Network
- Myeloma Euronet - European Network of Myeloma Patient Groups
- The Leukemia & Lymphoma Society's Myeloma Page
Health science - Medicine - Hematology
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