all right so let's talk about multiple
myeloma and I'd like to start by
introducing you to Babs and Babs is a 70
year old lady and over the past few
months she's been becoming really crabby
ung has all sorts of complaints and so
because of this I'm going to call her
Babs the crap so what are some of the
complaints that Babs has been
experiencing well first she's been
having some GI symptoms so things like
constipation nausea and a poor appetite
and I'll just represent that here she
also has been drinking a lot more than
normal and frequently complains of being
thirsty she has also been more tired
than normal and some of her family
members have noticed that her skin's
been maybe just a little bit more pale
than it usually is so I'm going to just
write that in here as fatigue and pallor
and then we can kind of maybe make her
skin look a little bit more pale here
and lastly she's been complaining of
this just constant dull lower back pain
now although each one of Babs complaints
here are in themselves fairly
nonspecific and vague when you take them
as a whole they're actually fairly
telling and an astute medical provider
would likely be concerned that she may
have multiple myeloma now before I talk
about why these symptoms here are
consistent with multiple myeloma let's
first just answer the question what is
multiple myeloma and multiple myeloma is
a malignancy or a cancer of plasma cells
and I'm going to just also star this
here because it's very important well
what are plasma cells well plasma cells
are a type of blood cell that produce
antibodies and antibodies are part of
the immune system they help our bodies
fight infection and there are four major
mechanisms of multiple myeloma that I
want to address here and this first
mechanism is a monoclonal production of
immunoglobulins or antibodies and I'm
going to just abbreviate immunoglobulins
IG well what do I mean by this well when
you have a malignancy of a plasma cell
that malignancy actually starts in just
a single
and that single cell replicates over and
over and over so what you get is this
increased production of the only the
type of antibody that that original cell
produces and these immunoglobulins are
actually proteins and the proteins can
precipitate and deposit in different
areas of the kidney and this results in
renal in renal failure or kidney failure
the next mechanism is an increased bone
turnover
so these malignant plasma cells release
certain factors into the blood that
affect to the bone and they cause the
bone to turn over to break down in a
sense and this increased bone turnover
results in what are known as lytic bone
lesions and they press predispose the
bone to fractures and this by this I
mean they make the bone more likely to
break and the most likely site of these
fractures are is in the spinal column
and as the bone is being turned over me
broken down it's also releasing calcium
so this results in hypercalcemia the
next mechanism is crowding of the bone
marrow
now before I describe this mechanism I
want to briefly go over what bone marrow
is so let me just draw a bone here so
bone marrow is in the center of bones
and it's where blood cells are produced
and so let's just draw in some blood
cells here so maybe some of the cells
that produce red blood cells and some of
the cells that produce platelets and
then some of the cells that would
produce plasma cells so this would be a
normal bone marrow producing the
different types of blood cells but when
you have a malignancy of these plasma
cells the plasmas the one type of plasma
cell is just growing uncontrollably and
you get this crowding out of the bone
marrow by only the plasma cells so the
bone marrow is no longer producing
enough red blood cells or platelets and
so this results in anemia and
thrombocytopenia
and an email refers to a low level of
red blood cells in the blood and
thrombocytopenia refers to a low level
of platelets in the blood then the last
mechanism is a decreased production of
normal immunoglobulins so once again
I'll abbreviate that IG which are
antibodies and if the body isn't able to
produce normal antibodies then the body
is not able to adequately fight off
infections so individuals with multiple
myeloma have an increased risk of
infection so you can see that some of
these colors here in the different
mechanisms of multiple myeloma correlate
with the symptoms of Babs the crab was
experiencing and that isn't a
coincidence and I'm going to start here
with the hypercalcemia and when someone
is has hypercalcemia they will
oftentimes experience certain GI
symptoms such as such as constipation
nausea and a poor appetite you can
remember this with this C here and then
I'll highlight the C over here and crab
and then the next one is this renal
failure and when someone has renal
failure sometimes they will there but
their kidneys won't be able to retain
water and so the individual become very
thirsty and so that's why Babs here had
this increased thirst because she was
having renal failure and so we'll just
highlight the are here in renal failure
and then the R over here in crab for
renal failure the next is the anemia
so what anemia it means is you have a
decreased amount of red blood cells and
red blood cells carry oxygen to the body
so if you don't have enough red blood
cells your body can't get enough oxygen
and so the body becomes fatigued the
skin also becomes pale so you have this
fatigue and pallor and due to the anemia
and so for a for anemia will just
highlight the a and crab over here and
then lastly you have these little bone
lesions that
have an increased risk of fractures and
so frequently people with multiple
myeloma will have this low back pain and
will highlight the be they are for bone
or back and that is that be and crab so
the reason that Babs a crab was all
crabby is because crab is actually just
an acronym to help you remember what is
happening in multiple myeloma someone
who has multiple myeloma will experience
hypercalcemia renal failure anemia and
bone lesions that cause back pain all
right so how do you diagnose multiple
myeloma well you can really just follow
through each of these categories to help
get an idea so with the renal failure
you can check certain blood levels like
bu n and creatinine which can show signs
of renal failure and then you can also
do a test called an electrophoresis and
what this is is a special test that
detects this monoclonal production of
IgG and it can be done on either the
serum or the urine and the result it has
is known as an M spike and this is a
little bit confusing and I don't want to
get into all the nitty-gritty details of
it but just remember that
electrophoresis will detect this
monoclonal production of IG and then for
the lytic bone lesions to diagnose that
you can do a bone scan hypercalcemia is
just type detected in the blood for the
anemia and thrombocytopenia the
diagnosis can be through a complete
blood count which will give you which
will show a decreased red blood cell
count and decrease platelet count or you
can see this crowding of the bone marrow
on a bone marrow biopsy so these are the
tests that you would do to diagnose
multiple myeloma now I'm going to just
briefly address the treatment of
multiple myeloma now like many areas of
cancer treatment the specific methods
for treating multiple myeloma rapidly
change so I'm not going to address any
specific medications that are used but
kind of just talk about a general
approach to treating multiple myeloma
and there's two major two general
approaches the first approach is to
treat the symptoms of the disease and
cause it and cause disease regression
and this is accomplished through
different medicines as well as
chemotherapy and then the other approach
for treatment of multiple myeloma is
curative and this is achieved through a
bone marrow transplant just abbreviate
that BM T and so obviously when you have
a cancer the goal is to cure the
individual however bone marrow
transplants can be very hard on in
people and since multiple myeloma like
in bads here is most common in the
elderly with a median age right around
70 years old oftentimes bone marrow
transplants aren't able to be performed
because the patient just would not
handle the treatment very well and so
the mainstay of treatment are certain
medications as well as chemotherapy so
just remember that multiple myeloma is a
malignancy or a cancer of plasma cells
and that crab is an acronym for the
effects of multiple myeloma with C
representing hypercalcemia R for renal
failure a for anemia and B for the lytic
bone lesions and low back pain