Understanding Multiple Myeloma

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Multiple myeloma (MM) is a plasma cell dyscrasia characterized by the proliferation of malignant cells in the bone marrow (Porth, 2009). Also known as plasma cell myeloma, myelomatosis, medullary plasmacytosis or Kahler’s disease, MM results from the development of a monoclonal immunoglobulin (referred to as an M-protein), a monoclonal immunoglobulin light chain, or both (Ferreira, 2013). Patients with MM can present with a wide range of signs and symptoms including bone fractures, anemia and kidney damage or no symptoms at all (Lobban & Perkins, 2013). This creates a diagnostic challenge to clinicians as many of these conditions are of benign etiology (Lobban & Perkins, 2013). The individual variations among patients with…show more content…
Patients with increased age, male gender, African American descent, familial incidence of MM or a history of other plasma cell disorders are all at higher risk of a developing MM (Lobban & Perkins, 2013). Radiation and exposure to agricultural chemicals like Agent Orange have been linked to MM (Kelly et al, 2010). Other risk factors include chronic immune stimulation, autoimmune disorders, and certain viruses including HIV infection (Porth, 2009). To understand the pathophysiology of MM, it is essential to understand the concept of B-cell maturation into plasma cells that release proteins called immunoglobulins (Kelly et al, 2010). Lymphoid stem cells in the bone marrow develop into either T or B lymphocytes (Kelly et al, 2010). The B lymphocyte is responsible for humoral immunity and can be identified by the presence of a membrane immunoglobulin (Sommer, 2009). There are five classes of immunoglobulins: IgG, IgA, IgM, IgD, and IgE (Sommer, 2009). Each immunoglobulin has “two identical light (L) chains and two identical heavy (H) chains to form a ‘Y’-shaped molecule” (Sommer, 2009, p. 365). The light chains are termed kappa or lambda and the heavy chains define the five classes of immunoglobulins (Kelly et al, 2010). Myeloma occurs when there is an overproduction of one of these immunoglobulins (Kelly et al, 2010). The immunoglobulin that

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