Multiple Myeloma: An Overview in 1996

Abstract

Multiple myeloma (MM) has an incidence of approximately four per 100,000 per year. Ninety-nine percent of patients with MM have a monoclonal (M-) protein in the serum or urine during the course of their disease. MM must be differentiated from smoldering multiple myeloma (SMM), which has an Mprotein value of more than 30 g/l and more than 10% plasma cells in the bone marrow, but no other features of MM. The plasma cell labeling index (PCLI) and the presence of circulating plasma cells in the peripheral blood help to differentiate monoclonal gammopathy of undetermined significance and SMM from MM. The current median duration of survival with chemotherapy is about three years. Patients with low PCLI and low β 2 -microglobulin values have a median duration of survival of approximately six years. Melphalan and prednisone produce an objective response in 50% to 60% of patients.Combinations of chemotherapy produce a higher response rate, but the survival rate is not different. Allogeneic bone marrow transplantation is associated with a mortality rate of 25% within six months and an actuarial survival rate of 28% at seven years. Autologous peripheral stem cell transplantation is applicable to more patients and is reported to produce a higher response rate and longer survival than chemotherapy, but most patients will eventually have relapse.

A Comprehensive Approach towards Serum Protein Electrophoresis Reporting with Relative Percentage and Gram as Addendum

“…The change in the pattern of TP in various clinical conditions in comparison with a normal/reference electrophoretogram showed an average of 6.8 ± 0.59 which was in accordance with the studies done by Luetscher [7] and Kaplan and Savory [8] where average TP was 6.5 g/dL and 7.5 g/dL respectively. Whereas in multiple myeloma, the mean TP value in our study was higher with 8.9 ± 1.9 which was similar to the studies done by Kyle [6,9,10] and Donald [11] in which TP was 9.1 g/dL and 8.5 g/dL, respectively, and is mainly due to the increase in monoclonal immunoglobulin band.…”

“…These are similar to the study done by Azim et al [18] and Simeon and Rukari. [12] Hypoalbuminemia is seen in multiple myeloma, nephropathy, chronic infection, malignancy, and retroviral infection in our study and was similar to the study done by Connell et al, [4] Kyle, [6,9,10] Azim et al [18] and Vavricka et al [19] The hypoalbuminemia was mainly due to malnutrition and protein loss.…”

“…The increase in gamma globulins mainly depends on the monoclonal or polyclonal increase in respective immunoglobulins. [6,9,10] TP values and other protein fractions In this study, the TP values were also associated with all individual protein fractions. The protein fractions were grouped as less than BRI, within BRI and more than BRI and then compared with their respective TP values.…”

“…[6,9,10] Out of 20 multiple myeloma cases (based on International Myeloma Working Group criteria), [23] 50% of them [10] had gamma globulins more than 3 g/dL and the remaining 50% had gamma globulins <3 g/dL. These are inconsistent with Mayo Clinic studies, [6,9,10] Tripathy [24] and Chopra et al [25] studies. Furthermore, 55% of the multiple myeloma cases had M spike in the gamma region, 10% in beta region, 25% had discrete band either in beta or gamma region with the remaining 5% showed hypergammaglobulinemia.…”