Multiple Myeloma
Basics
Description
Description
- Normal cells transform into myeloma cells at the hematopoietic stem cell level
- Pathologic derangements:
- Tumor cells within marrow lead to bone destruction and cytopenia
- Immunodeficiency develops secondary to suppression of normal immune functions
- Myeloma proteins lead to hyperviscosity and amyloidosis
- Multifactorial renal failure
- Plasma cell secretions activate osteoclasts, leading to:
- Bone lysis, pathologic fractures, and neurologic impairment
- Hypercalcemia (exacerbated by impaired renal function)
- Anemia due to marrow infiltration and renal insufficiency
- Immunocompromised due to:
- Decrease in the number of normal immunoglobulins
- Qualitative and quantitative defects in T- and B-cell subsets
- Granulocytopenia
- Decreased cell-mediated immunity
- Hyperviscosity secondary to protein accumulation:
- Leads to high-output congestive heart failure
- Myeloma light chains accumulate in the renal epithelial cells and destroy the entire nephron
- Clinical signs such as anemia, renal insufficiency, or lytic bone lesions
- Complications:
- Pathologic fractures
- Hypercalcemia
- Renal failure
- Recurrent infection
- Anemia
- Spinal cord compression (10% of all multiple myeloma [MM] patients)
Etiology
Etiology
- Incidence: 4/100,000 population:
- 1% of all cancers
- 10% of all hematopoietic malignancies
- 10,000 deaths/yr
- Mean age at diagnosis is 66 yr
- Slightly higher incidence in men and African Americans (reason unknown)
Pediatric Considerations
- Rarely seen in children
- <2% in patients <40 yr of age
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Citation
Schaider, Jeffrey J., et al., editors. "Multiple Myeloma." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307161/all/Multiple_Myeloma.
Multiple Myeloma. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307161/all/Multiple_Myeloma. Accessed December 5, 2024.
Multiple Myeloma. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307161/all/Multiple_Myeloma
Multiple Myeloma [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 05]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307161/all/Multiple_Myeloma.
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