(21) Multiple Myeloma
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Transcript of (21) Multiple Myeloma
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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.