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MULTIPLE MYELOMA

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Sahyuddin

Tutik HarjiantiSubdivisi Hematologi & Onkologi MedikBag. Ilmu Penyakit Dalam

FKUH

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Malignant Plasma Cells inMarrow

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* Multiple Myeloma

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= Mieloma Multipel (MM)

= Kahlers disease

= Keganasan sel plasma

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* Pendahuluan

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MM = keganasan sel plasma

1. Terjadi perubahan pada SST

2. Osteolitik & destruksi tulang

3. Terbtknya para-protein (prot abn)

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1. Perubahan SST

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Jumlah sel plasma sangat meningkat

Supresi mielopoesis secr humoral

anemia

keggl SST secr menyeluruh

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2. Destruksi tulang

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okOAF (osteoclast activating factor)

* nyeri tulang (bone-pain)

* osteo porosis/osteolitik : tl axial,

calvaria, vertb, prox tl panjang, iga* fraktur patologik

Akibat erosi tulanghiperkalsemia

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3. Sekresi protein abnormal

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Sel plasma maligna mensekresi suatu

para-protein = protein M (abnormal)

Umumnya berbtk IgG atau IgA

sindr.hiperviskositas

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3. Sekresi protein abnormal(2)

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Komponen rantai ringan (light-chain)

dari Ig gagal ginjal

(kdg2 diperberat oleh hiperkalsemia)

Katabolisme para-protein

amiloid gagal jantung & neuropati

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* Gbr. klinis

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Peny. lanjut usia (median : 60 th)

Anemia, LED tinggi

Nyeri tulang : costa, vertebra

Fraktur patologik: colum femoris Ggl ginjal, kompresi med.spinalis

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* Gbr. Klinis (2)

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Sindr.hiperviskositas : perdrh.mukosa,

nausea, vertigo, ggn visus, ggn jiwa.

Pucat, nyeri tulang, neuropati

Ggl jantung kongestif

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* Laboratorium

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Anemia ( normokrom )

LED sangat tinggi ( mis. 150 / 160 )

Hiperkalsemia ( Ca >> )

Proteinuria (Bence Jones protein) Elektroforesis protein serum abnormal

(spike monoclonal pd beta atau gamma)

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Serum Protein

ElectrophoresisNormal Monoclonal Protein in Myeloma

Kyle RA and Rajkumar SV. Cecil Textbook of Medicine, 22nd Edition, 2004

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* Terapi

1. Simtomatik (bone-pain dsb)

2. Melphalan/Alkeran + prednisone

Kombinasi kemotx (alkylating)

3. Radiotx local (nyeri/frakt patologik)

4. Hindari immobilisasi lama 5. Hindari dehidrasi

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* Prognosis

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Median survival : 3 thn

Px lbh buruk pada : spikes paraprotein

sangat tinggi, ggl ginjal, hiperkalsemia

& ggn tulang yg ekstensif.

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* Prognosis (2)

High Tumor Burden :

spike IgG > 7 g/dl

hematokrit < 25 %

ca serum > 12 mg/dl

atau lesi osteolitik > 3 lokasimedian survival 1 thn.