Narrative of Pathophysiology:
In multiple myeloma, the DNA of plasma cells has been damaged, causing them to become malignant or cancerous. Instead of forming a lump ortumour, these abnormal plasma cells, which then become known as myeloma cells, divide and expand within the bone marrow. marrow.Multiple myeloma develops myeloma develops in lymphocytes after they have left the part of the lymph node known as the germinal center. !he normal cell line most closely associated with Multiple Myeloma cells is generally taken to be either an activated memory cell or the precursor to plasma cells, the plasmablast."roduce adhesive molecules and bind to one Marrow #tromal $ells. Malignant plasmablast grows into malignant malignant plasma cells. As a result there will be uncontrolled uncontrolled proliferation proliferation of malignant plasma cell clones. %hen %hen ther there e is abnor bnorma mall prod produc ucti tion on of myel myelom oma a cell cells s a form format atio ion n of plasmacytomas plasmacytomas will result. !here will be compression compression of surrounding surrounding bone tissue, bone marrow and nerve nerve endings which can lead lead to destruction of one one $ell Marrow. Marrow. %hen there is destruction of bone cell marrow it will decrease osteoblast which is a bone forming cell and decrease hematopoiesis resulting to low &$, Megakaryocytes, and %$. 'eading to Anemia, !hrombocytopenia resulting to bleeding, and leukopenia resulting to increase susceptibility to any infections. Another thing that plasmacytoma plasmacytoma cause is the release of I'() and !umor !umor Necrosis *actor which recruits and activates the osteoclast +cell that functions in the breakdown and resorption of bone tissue. %hen it is attached to the bone tissue it produces such acid and en-ymes produced by osteoclasts are capable of removing the inorganic calcium and phosphorus from the bone tissue. tissue . !hey can also break down organic material, such as collagen, that constitutes the bone itself. Initially, the bone is broken apart with the minerals still inside of the tissue and forms osteolytic osteolytic lesions. !herefore there is continuous continuous bone destruction destruction that may cause pathologic fracture. fracture. nce bone is destructed $alcium will be released in the bloodstream arising to hypercalcemia and will further contribute to the formation of kidney stone thus may result to kidney failure. 62 | M U L T I P L E M Y E L O M A
"roduction and release of paraprotein +M protein from the multiple myeloma into the blood stream and/or urine 0 !he multiple myeloma cells usually produce a large amount of one type of abnormal antibody. !his is known as aparaprotein. !his paraprotein cannot fight infection effectively and often reduces the production of normal antibodies. &eduction of normal immune function, which causes reduced levels of normal immunoglobulins and increased susceptibility to infection. !here is also an increase in serum monoclonal antibodies from the production of "araprotein that will bind to the serum protein resulting to 1yperviscosity syndrome. It refers to any state in which there is increased viscosity of the blood. Increased serum viscosity usually results from increased circulating serum immunoglobulins +eg, macroglobulinaemia, multiple myeloma and can also result from increased cellular blood components +eg, red or white blood cells in hyperproliferative states ( eg, leukaemias, polycythaemia and thrombocythaemia. !he underlying cause of the hyperviscosity syndrome may be treated with chemotherapy where appropriate. $linical se2uel of 13# can include congestive heart failure, ischemic acute tubular necrosis, and pulmonary edema and if left untreated it will result to death. Another result of proliferation of myeloma cells is the production of ence 4ones proteins. ence 4ones protein is a monoclonal globulin protein or immunoglobulin light chain found in the urine. !hey are found in urine due to the kidneys5 decreased filtration capabilities due to renal failure, sometimes induced by hypercalcemia from the calcium released as the bones are destroyed or from the light chains themselves. &esulting to proteinuria or 6idney *ailure. In this type of plasma cell neoplasm, the abnormal plasma cells +myeloma cells collect in one location and form a single tumor, called a plasmacytoma. !he aim of treatment is to eliminate the plasmacytoma. !he treatment that is used most commonly for both types of plasmacytoma is radiotherapy. !his involves focusing radiation +similar to 7(rays on the plasmacytoma to kill the malignant cells. !he treatment is generally given over several days to reduce side(effects8 each treatment dose of radiotherapy is
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known as 9a fraction:.!he addition of chemotherapy to radiotherapy treatment can be advantageous. Multiple myeloma remains incurable despite recent remarkable advances in therapy. !reatment is aimed at preventing or relieving symptoms and complications, destroying abnormal plasma cells, and slowing progression of the disorder.!he most consistently helpful group of drugs for multiple myeloma is corticosteroids, such as prednisone, methylprednisolone, or dexamethasone, although many new drugs are showing great promise. In addition, chemotherapy slows the progression of multiple myeloma by killing the abnormal plasma cells. ecause chemotherapy kills normal cells as well as abnormal ones, the blood cells are monitored and the dose is ad;usted if the number of normal white blood cells and platelets decreases too much. !reatment is aimed at reducing the tumor burden, preventing and controlling complications +e.g., infections, anemia, hypercalcemia, pathologic fractures, and managing pain. !he goal is to maintain as much mobility as possible.
#urvival time varies widely depending on certain features, such as kidney problems, blood levels of certain proteins including beta <(microglobulin and serum albumin, and genetic characteristics, at the time of diagnosis and the response to treatment. Importantly, bisphosphonates to reduce bony complications, substances that stimulate the production of blood cells +growth factors to increase the number of red and white blood cells, and better pain relievers have also greatly improved the 2uality of life.
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