Multiple myeloma is a cancer that starts in plasma cells.
Development[ edit ] The genetic and epigenetic changes just described occur in a step-wise fashion. The initial change, often involving one of the cited chromosome 14 translocations, establishes a clone of bone marrow plasma cells that causes the asymptomatic disorder termed monoclonal gammopathy of undetermined significance MGUS.
MGUS is a premalignant disorder characterized by increased numbers of plasma cells in the bone marrow or the circulation of a myeloma Multiple myeloma immunoglobulin.
Further genetic or epigenic changes produce a new clone of bone marrow plasma cells, usually descendant from the original clone, that causes a more serious but still asymptomatic premalignant disorder termed smoldering multiple myeloma.
Smoldering multiple myeloma is characterized by a rise in the number of bone marrow plasma cells or levels of the circulating myeloma protein above that seen in MGUS. Subsequent genetic and epigenetic changes lead to a new, more aggressive clone of plasma cells which cause further rises Multiple myeloma the level of the circulating myeloma protein, further rises in the number of bone marrow plasma cells, or the development of one or more of a specific set of "CRAB" symptoms see diagnostic section below.
These last changes are the basis for diagnosing malignant multiple myeloma and treating the disease. In a small percentage of multiple myeloma cases, further genetic and epigenetic changes lead to the development of a plasma cell clone that moves from the bone marrow into the circulation, invades distant tissues, and thereby causes the most malignant of all plasma cell dyscrasias, plasma cell leukemia.
Blood tests[ edit ] Serum protein electrophoresis showing a paraprotein peak in the gamma zone in a patient with multiple myeloma.
The globulin level may be normal in established disease. A doctor will request protein electrophoresis of the blood and urine, which might show the presence of a paraprotein monoclonal protein, or M protein band, with or without reduction of the other normal immunoglobulins known as immune paresis.
One type of paraprotein is the Bence Jones protein which is a urinary paraprotein composed of free light chains see below.
Quantitative measurements of the paraprotein are necessary to establish a diagnosis and to monitor the disease. The paraprotein is an abnormal immunoglobulin produced by the tumor clone.
In theory, multiple myeloma can produce all classes of immunoglobulin, but IgG paraproteins are most common, followed by IgA and IgM. IgD and IgE myeloma are very rare. In addition, light and or heavy chains the building blocks of antibodies may be secreted in isolation: On peripheral blood smear, the rouleaux formation of red blood cells is commonly seen, though this is not specific.
The recent introduction of a commercial immunoassay for measurement of free light chains potentially offers an improvement in monitoring disease progression and response to treatment, particularly where the paraprotein is difficult to measure accurately by electrophoresis for example in light chain myeloma, or where the paraprotein level is very low.
Initial research also suggests that measurement of free light chains may also be used, in conjunction with other markers, for assessment of the risk of progression from monoclonal gammopathy of undetermined significance MGUS to multiple myeloma.
Micrograph showing myeloma cast nephropathy in a kidney biopsy. Myelomatous casts are PAS negative pale pink - left of image. Histopathology[ edit ] A bone marrow biopsy is usually performed to estimate the percentage of bone marrow occupied by plasma cells.
This percentage is used in the diagnostic criteria for myeloma. Immunohistochemistry staining particular cell types using antibodies against surface proteins can detect plasma cells which express immunoglobulin in the cytoplasm and occasionally on the cell surface; myeloma cells are often CD56CD38CDCD positive and CD19CD20 and CD45 negative.
Cytogenetics may also be performed in myeloma for prognostic purposes, including a myeloma-specific FISH and virtual karyotype.
The plasma cells seen in multiple myeloma have several possible morphologies. First, they could have the appearance of a normal plasma cell: Because they are actively producing antibodies, the Golgi apparatus will typically produce a light-colored area adjacent to the nucleus, called a perinuclear halo.
The single nucleus with inside a single nucleolus with vesicular nuclear chromatin is eccentric, displaced by an abundant cytoplasm.
Other common morphologies that are seen, but which are not usual in normal plasma cells, include: Bizarre cells, which are multinucleated. Mott cells, containing multiple clustered cytoplasmic droplets or other inclusions sometimes confused with auer rodscommonly seen in myeloid blasts Flame cells, having a fiery red cytoplasm.
However, this antigen disappears rapidly ex vivo. Recently, however, it was discovered that the surface antigen CD SLAMF7 is considerably more stable and allows robust isolation of malignant plasma cells from delayed or even cryopreserved samples. This is a series of X-rays of the skull, axial skeleton and proximal long bones.Multiple myeloma is a blood cancer that starts in the plasma cells in the bone marrow.
Bone marrow is the soft, spongy tissue found inside most bones. Myeloma. Is a type of cancer that begins in the bone marrow. It is a cancer of plasma cells, which are a type of white blood cells (also called plasma B cells). Plasma cell neoplasms (including multiple myeloma) treatment include observation, chemotherapy, radiation, stem cell rescue, targeted, and supportive therapies.
Corticosteroids and immunomodulatory drugs may be used. Get detailed treatment information in this summary for clinicians.
If you have multiple myeloma or are close to someone who does, knowing what to expect can help you cope. Here you can find out all about multiple myeloma, including risk factors, symptoms, how it is found, and how it is treated.
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Multiple myeloma, also known as plasma cell myeloma, is a cancer of plasma cells, a type of white blood cell normally responsible for producing antibodies. Often, no symptoms are noticed initially. When advanced, bone pain, bleeding, frequent infections, and anemia may occur. Complications may include amyloidosis..
The cause is unknown. Risk factors include obesity, radiation exposure, family.