Jesse C James MDAM Report May 7, 2010

Proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein

Malignant plasma cells are responsible for clinical manifestations

Part of a spectrum of diseases ranging from monoclonal gammopathy of unknown significance to plasma cell leukemia

Presentations range from asymptomatic to severe complications

MM accounts for 1% of all American cancers. More frequent in men than women. AfA>WA>AsA

Median age 66◦ Anemia 73% (normochromic normocytic)◦ Bone Pain 58% (typically chest/back)◦ Elevated Creatinine 48% ◦ Fatigue/Malaise 32%◦ Hypercalcemia 28%

CBC w diff, peripheral smear (rouleaux) Ca++, albumin, protein SPEP (87% sensitive); UPEP (75% sensitive) Bone Marrow Aspiration

◦ >10% plasmocytosis, may be focal Bone Scan

MAJOR CRITERIA I Plasmacytoma on tissue biopsy II Bone marrow with greater than 30% plasma cells III Monoclonal globulin spike SPEP w IgG peak > 3.5

g/dL or an IgA peak of > 2 g/dL, or UPEP (w amyloidosis) > 1 g/24hr

MINOR CRITERIA A Bone marrow with 10-30% plasma cells B Monoclonal globulin spike present but less than

category III C Lytic bone lesions D Residual IgM level less than 50 mg/dL, IgA level

less than 100 mg/dL, or IgG level less than 600 mg/dL

Supportive Therapy◦ Renal: plasmapheresis◦ Anemia: transfusion◦ Pain: analgesics, palliative radiation ◦ Spinal compression: immediate corticosteroids

Chemotherapy◦ Regimen based on pt age, staging, and prognostic

factors◦ VAD: vincristine, doxorubicin (Adriamycin), and

dexamethasone◦ Thalidomide ◦ Bortezomib◦ Revlimid