Multiple+Myeloma

Stage 1: All of the following: hemoglobin >10g/dL, serum calcium normal (<12mg/dL), on roetgenogram, normal bone structure or solitary bone plasmacytoma only, low M-component production rates, lgG< 5 g/dL, lgA < 3 g/dL, urine light chain M-component on electrophoresis < 4 g/24h Stage 2: Overall data as minimally abnormal as shown for Stage 1 and no single value as abnormal as defined for stage III. Stage 3: One or more of the following: hemoglobin <8.5g/dL, serum calcium >12 mg/dL, advanced lytic bone lesions, high M component productions rates, lgG> 7 g/dL, lgA>5g/dL, urine light chain M component on electrophoresis > 12 g/24 hr || • Kidney function • Protein blood levels - Beta2-microglobulin - Serum albumin • Genetic characteristics
 * **Epidemiolgy:** || 2-3 cases per 100,000 cases per year. [2] ||
 * **Etiology:** || caused by proliferation and accumulation of immunoglobulin-secreting cells [2] ||
 * **Signs & Symptoms:** || bone pain, infection, bleeding, fatigue, anemia, thrombocytopenia, granulocytopenia, hypercalcemia. [2] ||
 * **Diagnostic Procedures:** || The initial diagnostic workup includes; a complete medical history, a comprehensive physical examination, and laboratory studies. The medical imaging studies used to detect any lytic lesions include x-rays, magnetic resonance imaging, and computed tomography. Multiple myeloma activities can appear as a lytic lesion, also known as local absences of normal bone. A bone marrow biopsy is often used to evaluate the percentage of bone marrow taken by plasma cells. This is used as a diagnostic criteria and is recommended by the International Myeloma Working Group. [3] ||
 * **Histology:** || Multiple Myeloma arises in B-lymphocytes and is characterized by neoplastic proliferation of a single copy of plasma cells. It produces proteins that can damage bone structure. [3] ||
 * ======**Lymph node drainage:**====== || The lymph node drainage deos not play part in multiple multiple myeloma. ||
 * **Metastatic spread:** || May metastasize to anywhere in the body. ||
 * **Grading:** || Symptoms are graded on a scale of 0 (no symptoms) to 4 (severe symptoms). ||
 * **Staging:** || Durie-Salmon Staging [1]
 * **Radiation side effects:** || Patients may feel tired and lose their appetite. The skin above the treated area are more sensitive and irritated. Other side effects may also include peripheral neuropathy, clinical thrombocytopenia and diarrhea. Fibrosis, contractures and growth arrest may also be presented. [1] ||
 * **Prognosis:** || There is no cure for multiple myeloma. The length of survival will vary depending on the following factors:

Many individuals will respond well to chemotherapy, however will ultimately die from complication due to chemotherapy, develop leukemia and /or loss of bone marrow function.[2] || • Melphalan frequently in combination with prednisone
 * **Treatments:** || Chemotherapy[2]

Radiation therapy [2] • Symptomatic bony lesions should be treated with portals that encompass the entire bone, if possible (i.e. extremity) • Primarily aimed at palliation or pain relief • Palliative dose of 15-20 Gy in disseminated myeloma • Keep fields in pelvis and other areas of abundant bone marrow as small as possible to maximize marrow function for future chemotherapy • Hemi body irradiation is of value in patients with diffusely painful sites of disease (median dose is 7.5 8.5 Gy) ||
 * **TD 5/5:** ||  || Organ of Interest

Bone marrow

Bone

Spinal cord || TD 5/5 1/3

250 cGy

-

5,000 cGy 5cm || TD 5/5 2/3

250 cGy

-

5,000 cGy 10cm || TD 3/3

250 cGy

2,000 cGy 10 cm3 4,700 cGy 20 cm || Complication

Aplasia

Growth arrest

Myelitis/Necrosis ||  || [2] Chao KS, Perez C, Brady L. //Radiation Oncology Management Decisions.// 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. [3] Hoppe TR, Phillips LT, Roach M. //Leibel and Phillips Textbook of Radiation Oncology//. 3rd Ed. Philadelphia, PA: Saunders, Elsevier; 2010. || Back to Week 7
 * **References:** || [1] Erber WN. //Diagnostic Techniques in Hematological Malignancies//. New York, NY: Cambridge University Press; 2010.