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Jesse C James MD AM Report May 7, 2010
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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
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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%
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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
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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
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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
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