Plasma cell disorder: Difference between revisions

Jump to navigation Jump to search
(→‎Plasma-cell leukemia: secondary plasma cell leukemia)
 
(41 intermediate revisions by 3 users not shown)
Line 2: Line 2:


{{Plasma cell disorder}}
{{Plasma cell disorder}}
{{CMG}};  {{AE}} {{N.F}}
{{CMG}};  {{AE}} {{N.F}}, {{Anmol}}
 


{{SK}} Plasma cell dyscrasia


==[[Plasma cell disorder overview|Overview]]==   
==[[Plasma cell disorder overview|Overview]]==   


Plasma cell disorders are a diverse type of blood disorders characterized by the presence of a monoclonal paraprotein in the [[serum]] or urine.  Monoclonal plasma cells are present in the [[bone marrow]] or, rarely, in other tissues. Plasma cell disorders include [[Monoclonal gammopathy of undetermined significance classification|monoclonal gammopathy of undetermined significance]] (MGUS)[[Multiple myeloma|, multiple myeloma]] (MM), [[lymphoplasmacytic lymphoma]]/ [[Waldenström's macroglobulinemia|Waldenstrom macroglobulinemia]]  (LPL/WM), [[Lymphoproliferative disorders|lymphoproliferative disorders,]] smoldering multiple myeloma (SMM); solitary or extramedullary plasmacytoma,  [[amyloidosis]], and [[POEMS syndrome]] (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein, and Skin changes). Plasma-cell disorders are characterized by the proliferation of a single clone of plasma cells that produces a homogeneous monoclonal (M) protein. These disorders have been defined by the International Myeloma Working Group.1 In 2006.  
Plasma cell disorders are a diverse type of blood disorders characterized by [[proliferation]] of a single clone of [[plasma cells]] that produces a [[homogeneous]] monoclonal (M) protein. These monoclonal paraprotein are seen in the [[serum]] or urine.  Monoclonal [[plasma cells]] are present in the [[bone marrow]] or, rarely, in other tissues. Plasma cell disorders include [[Monoclonal gammopathy of undetermined significance classification|monoclonal gammopathy of undetermined significance]] (MGUS)[[Multiple myeloma|, multiple myeloma]] (MM), [[lymphoplasmacytic lymphoma]] or [[Waldenström's macroglobulinemia|Waldenstrom macroglobulinemia]]  (LPL/WM), [[Lymphoproliferative disorders|lymphoproliferative disorders,]] smoldering multiple myeloma (SMM); solitary or extramedullary plasmacytoma,  [[amyloidosis]], and [[POEMS syndrome]] ([[polyneuropathy]], [[Organomegaly|organomegaly,]] [[endocrinopathy]], monoclonal protein, and skin changes). These disorders have been defined by the International Myeloma Working Group in 2006.  


==[[Plasma cell disorder classification|Classification]]==
==[[Plasma cell disorder classification|Classification]]==
Line 14: Line 14:
{{family tree | | | | | | | | | | | | A01 | | | | | | | | | | | | | | A01=Plasma cell disorder}}
{{family tree | | | | | | | | | | | | A01 | | | | | | | | | | | | | | A01=Plasma cell disorder}}
{{family tree | |,|-|-|-|v|-|-|-|v|-|-|^|-|-|v|-|-|-|v|-|-|-|.| | | }}
{{family tree | |,|-|-|-|v|-|-|-|v|-|-|^|-|-|v|-|-|-|v|-|-|-|.| | | }}
{{Family tree | B01 | | B02 | | B03 | | | | B04 | | B05 | | B06 | | B01=[[Monoclonal gammopathy of unknown significance]] (MGUS)|B02=Malignant monoclonal gammopathy|B03=[[Chronic lymphocytic leukemia]] |B04=Heavy chain diseases
{{Family tree | B01 | | B02 | | B03 | | | | B04 | | B05 | | B06 | | B01=[[Primary amyloidosis]]|B02=[[Plasma cell disorder#Malignant monoclonal gammopathies|Malignant monoclonal gammopathy]]|B03=[[Chronic lymphocytic leukemia]] |B04=[[plasma cell disorder#Heavy-chain diseases|Heavy chain diseases (HCD)]]| B05=[[Cryoglobulinemia]] | B06=[[Monoclonal gammopathy of undetermined significance]] (MGUS)}}
γHCD
{{Family tree | | | | | |!| | | | | | | | | |!| | | | | | | |!| | | }}
αHCD
{{Family tree | | |,|-|-|^|-|.| | | |,|-|-|-|+|-|-|-|.| | | |!| | | }}
μHCD | B05=[[Cryoglobulinemia]] | B06= [[Primary amyloidosis]]}}
{{Family tree | | C01 | | | C02 | | C03 | | C04 | | C05 | | |!| | | |C01=[[Multiple myeloma]]|C02=[[Plasma cell disorder#Malignant lymphoproliferative disorders|Malignant lymphoproliferative disorders]]|C03=[[Plasma cell disorder#γHCD|γHCD]]|C04=[[Plasma cell disorder#αHCD|αHCD]]|C05=[[Plasma cell disorder#μHCD|μHCD]]}}
{{Family tree | | | | | |!| | | | | | | | | | | | | | | | }}
{{family tree | | |!| | | | |!| | | | | | | | | | | | | | | |!| | | }}
{{Family tree | |,|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | }}
{{family tree | | |!| | | | |!| | | | | |,|-|-|-|v|-|-|-|v|-|^|-|.|}}
{{Family tree | | C01 | | | | | | | | | C02 | | | | | | | | | | | | |C01=[[Multiple myeloma]]|C02=[[Malignant lymphoproliferative disorders]]}}
{{family tree | | |!| | |,|-|^|-|.| | | F01 | | F02 | | F03 | | F04 | |F01= [[Benign]]<br>(IgG, IgA, IgD, IgM, and,<br>rarely, free light chains)|F02=Associated [[Neoplasm|neoplasms]]<br>or other diseases not known to<br>produce monoclonal proteins|F03=Biclonal and triclonal<br>[[Gammopathy|gammopathies]]|F04= Idiopathic<br>(Bence Jones<br>proteinuria)}}
{{family tree | | |!| | | | | | | | | | |!| | | | | | | | | }}
{{family tree | | |!| | D01 | | D02 | | | | | | | | | | | | | | | | |D01=[[Waldenstrom macroglobulinemia]] | D02=[[Malignant lymphoma]]}}
{{family tree | | |!| | | | | | | | |,|-|^|-|-|.| | | | | | }}
{{family tree | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{family tree | | |!| | | | | | | | D01 | | D02 | | | | | | | | D01=[[Waldenstrom macroglobulinemia]] | D02=[[Malignant lymphoma]]}}
{{family tree | |,|^|-|-|v|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|.|}}
{{family tree | | |!| | | | | | | | | | | | | | | | | | | | }}
{{family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | | E08 | | E01=[[Plasma cell disorder#Symptomatic multiple myeloma|Symptomatic multiple myeloma]] | E02=[[Plasma cell disorder#Smoldering multiple myeloma|Smoldering multiple myeloma]] | E03=[[Plasma cell disorder#Plasma-cell leukemia|Plasma-cell leukemia]]|E04=[[Plasma cell disorder#Non-secretory myeloma|Non-secretory myeloma]] |E05=[[Plasma cell disorder#IgD myeloma|IgD myeloma]] | E06=[[Plasma cell disorder#Osteosclerotic myeloma|Osteosclerotic myeloma]] | E07=[[Plasma cell disorder#Solitary plasmacytoma of bone|Solitary plasmacytoma of bone]] |E08=[[Plasma cell disorder#Extramedullary plasmacytoma|Extramedullary plasmacytoma]]}}
{{family tree | |,|^|-|-|v|-|-|-|v|-|-|-|v|-|-|-|v|-| |-|-|v|-|-|-|v|-|-|-|.| | | | | | | | | | |}}
{{family tree | E01 | | E02 | | E03 | | E04 | | E05 | | | E06 | | E07 | | E01=[[Symptomatic multiple myeloma]] | E02=[[Smoldering multiple myeloma]] | E03=[[Plasma-cell leukemia]]|E04=Non-secretory myeloma | E05=[[Solitary plasmacytoma]] of bone | E06=[[Osteosclerotic myeloma]] | E07=[[Extramedullary plasmacytoma]]}}
{{Family tree/end}}
{{Family tree/end}}


 
==[[Plasma cell disorder| Differential Diagnosis]]==
=== Monoclonal gammopathies of undetermined significance (MGUS) ===
* Benign (IgG, IgA, IgD, IgM, and, rarely, free light chains)
* Associated neoplasms or other diseases not known to produce monoclonal proteins
* Biclonal and triclonal gammopathies
* Idiopathic (Bence Jones proteinuria)
 
=== Malignant monoclonal gammopathies ===
* '''Multiple myeloma''' (IgG, IgA, IgD, IgE, and free light chains)
** Symptomatic [[multiple myeloma]]
** Smoldering multiple myeloma
** Plasma-cell leukemia
** Non-secretory myeloma
** IgD myeloma
** POEMS syndrome: polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes (osteosclerotic myeloma)
** Solitary plasmacytoma of bone
** Extramedullary plasmacytoma
* '''Malignant lymphoproliferative disorders'''
** [[Waldenström's macroglobulinemia|Waldenstrom macroglobulinemia]]
** [[Malignant lymphoma]]
 
=== Chronic lymphocytic leukemia ===
 
=== Heavy-chain diseases (HCDs) ===
** γHCD
** αHCD
** μHCD
 
=== Cryoglobulinemia ===
 
=== Primary amyloidosis (AL) ===
 
== [[Plasma cell disorder| Differential Diagnosis]] ==
{| class="wikitable"
{| class="wikitable"
|+
|+
Line 96: Line 62:
| style="background:#F5F5F5;" align="center" + |N/A
| style="background:#F5F5F5;" align="center" + |N/A
| style="background:#F5F5F5;" align="center" + |<10%
| style="background:#F5F5F5;" align="center" + |<10%
| style="background:#F5F5F5;" align="center" + |No end-organ
| style="background:#F5F5F5;" align="left" + |
damage
*No end-organ damage
|-
|-
| style="background:#DCDCDC;" align="center" + |Smoldering MM
| style="background:#DCDCDC;" align="center" + |Smoldering MM
Line 108: Line 74:
| style="background:#F5F5F5;" align="center" + |N/A
| style="background:#F5F5F5;" align="center" + |N/A
| style="background:#F5F5F5;" align="center" + |10-60%
| style="background:#F5F5F5;" align="center" + |10-60%
| style="background:#F5F5F5;" align="center" + |
| style="background:#F5F5F5;" align="left" + |
* No myeloma-defining event  
*No myeloma-defining event
* No  CRAB features
*No  CRAB features
|-
|-
| style="background:#DCDCDC;" align="center" + |[[Monoclonal gammopathy of undetermined significance|Light chain MGUS]]
| style="background:#DCDCDC;" align="center" + |[[Monoclonal gammopathy of undetermined significance|Light chain MGUS]]
Line 119: Line 85:
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |<500 mg/24 hrs (urine)
| style="background:#F5F5F5;" align="center" + |<500 mg/24 hrs (urine)
| style="background:#F5F5F5;" align="center" + |Free kappa or lambda light chain
| style="background:#F5F5F5;" align="center" + |Free kappa or lambda light chain<br>Abnormal ratio (<0.26 or >1.65)<br>Increase in involved light chain concentration
Abnormal ratio (<0.26 or >1.65)
 
Increase in involved light chain concentration
| style="background:#F5F5F5;" align="center" + |<10%
| style="background:#F5F5F5;" align="center" + |<10%
| style="background:#F5F5F5;" align="center" + |No end-organ damage
| style="background:#F5F5F5;" align="left" + |
*No end-organ damage
|-
|-
| style="background:#DCDCDC;" align="center" + |[[Multiple myeloma classification|Active symptomatic Multiple myeloma]]
| style="background:#DCDCDC;" align="center" + |[[Multiple myeloma classification|Active symptomatic Multiple myeloma]]
Line 135: Line 99:
| style="background:#F5F5F5;" align="center" + |>100
| style="background:#F5F5F5;" align="center" + |>100
| style="background:#F5F5F5;" align="center" + |>60%
| style="background:#F5F5F5;" align="center" + |>60%
| style="background:#F5F5F5;" align="center" + |
| style="background:#F5F5F5;" align="left" + |
* ≥1 myeloma-defining event
*≥1 myeloma-defining event
 
*CRAB features
* CRAB features
|-
|-
| style="background:#DCDCDC;" align="center" + |[[Waldenström's macroglobulinemia|Waldenstrom macroglobulinemia]]
| style="background:#DCDCDC;" align="center" + |[[Waldenström's macroglobulinemia|Waldenstrom macroglobulinemia]]
Line 149: Line 112:
| style="background:#F5F5F5;" align="center" + |N/A
| style="background:#F5F5F5;" align="center" + |N/A
| style="background:#F5F5F5;" align="center" + |>10%
| style="background:#F5F5F5;" align="center" + |>10%
| style="background:#F5F5F5;" align="center" + |
| style="background:#F5F5F5;" align="left" + |
* Evidence of organ/tissue damage.
*Evidence of organ/tissue damage
 
*[[Anemia]]
* Anemia,
*[[Hepatosplenomegaly]]
* Hepatosplenomegaly
|-
|-
| style="background:#DCDCDC;" align="center" + |Solitary Plasmacytoma
| style="background:#DCDCDC;" align="center" + |Solitary Plasmacytoma
Line 163: Line 125:
| style="background:#F5F5F5;" align="center" + |<3mg/dl
| style="background:#F5F5F5;" align="center" + |<3mg/dl
| style="background:#F5F5F5;" align="center" + |Abnormal in 47% cases
| style="background:#F5F5F5;" align="center" + |Abnormal in 47% cases
| style="background:#F5F5F5;" align="center" + |Normal  
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |
| style="background:#F5F5F5;" align="left" + |
* Solitory bone lesion due to plasma cell tumor
*Solitory bone lesion due to [[plasma cell]] tumor
 
*Preserved levels of uninvolved [[immunoglobulins]]
* Preserved levels of uninvolved immunoglobulins
*No [[anemia]], [[hypercalcemia]] or [[renal disease]]
 
* No anemia, hypercalcemia or renal disease
|-
|-
| style="background:#DCDCDC;" align="center" + |[[AL amyloidosis|Primary amyloidosis]]
| style="background:#DCDCDC;" align="center" + |[[AL amyloidosis|Primary amyloidosis]]
Line 178: Line 138:
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |<3md/dl
| style="background:#F5F5F5;" align="center" + |<3md/dl
| style="background:#F5F5F5;" align="center" + |[[Light chain|Light chains]] of [[Immunoglobulin|immunoglobulines]]  
| style="background:#F5F5F5;" align="center" + |[[Light chain|Light chains]] of [[Immunoglobulin|immunoglobulines]]
| style="background:#F5F5F5;" align="center" + |<10%
| style="background:#F5F5F5;" align="center" + |<10%
| style="background:#F5F5F5;" align="center" + |
| style="background:#F5F5F5;" align="left" + |
* No bone lesions,
*No bone lesions
*[[Nephrotic syndrome]]
*[[Restrictive cardiomyopathy]]
*[[Peripheral neuropathy]]
*[[Hepatomegaly]] with elevated [[liver enzymes]]
*[[Macroglossia]]
*[[Purpura]] and an unexplained [[Hemorrhagic diathesis|bleeding diathesis]]
|-
| colspan="10" style="background:#DCDCDC;" align="left" + |
*Myeloma defining events: >60% clonal plasma cells on B.M exam; serum involved: uninvolved FLC ratio >100; >1 focal lesion on MRI >5mm
*CRAB features: elevated calcium >11mg/dl, renal insufficiency, '''a'''nemia Hb <10 g/dL , bone disease ≥1 lytic lesions on skeletal radiography, CT, or PET-CT , SFLC: serum free light chains, kappa and lambda immunoglobulin light chains.
*The normal κ:λ ratio is 0.26 to 1.65 (17,18). A κ:λ ratio of <0.26 strongly suggests the presence of a  of plasma cells that are producing clonal λ free light chains. Ratio >1.65 suggests production of clonal κ free light chains.
|}
 
==Monoclonal gammopathies of undetermined significance (MGUS)==
 
*[[Monoclonal gammopathy of undetermined significance]] is a condition in which a low or non-quantifiable level of a [[monoclonal]] [[paraprotein]] is detected in the blood by means of [[protein electrophoresis]].<ref name="pmid16628189">{{cite journal |vauthors=Jego G, Bataille R, Geffroy-Luseau A, Descamps G, Pellat-Deceunynck C |title=Pathogen-associated molecular patterns are growth and survival factors for human myeloma cells through Toll-like receptors |journal=Leukemia |volume=20 |issue=6 |pages=1130–7 |date=June 2006 |pmid=16628189 |doi=10.1038/sj.leu.2404226 |url=}}</ref><ref name="pmid19181642">{{cite journal |vauthors=Dinarello CA |title=Targeting the pathogenic role of interleukin 1{beta} in the progression of smoldering/indolent myeloma to active disease |journal=Mayo Clin. Proc. |volume=84 |issue=2 |pages=105–7 |date=February 2009 |pmid=19181642 |pmc=2664579 |doi=10.4065/84.2.105 |url=}}</ref><ref name="pmid23233640">{{cite journal |vauthors=Merlini G, Palladini G |title=Differential diagnosis of monoclonal gammopathy of undetermined significance |journal=Hematology Am Soc Hematol Educ Program |volume=2012 |issue= |pages=595–603 |date=2012 |pmid=23233640 |doi=10.1182/asheducation-2012.1.595 |url=}}</ref>
*<nowiki/>In addition, some patients develop a [[polyneuropathy]]<nowiki/> or other problems related to the secreted antibody.
*MGUS is a premalignant condition and is distinct fr<nowiki/>om [[multiple myeloma]].
*Pathologically, the lesion in [[Monoclonal gammopathy of undetermined significance]] is in fact very similar to that in [[multiple myeloma]].
 
For more information about monoclonal gammopathies of undetermined significance  '''[[Monoclonal gammopathies of undetermined significance |click here]].'''
 
==Malignant monoclonal gammopathies==
 
==='''Multiple myeloma'''===
 
====Symptomatic multiple myeloma====
 
*People with [[Multiple myeloma classification|multiple myeloma]] with symptoms are categorized to have [[Multiple myeloma Classification|active multiple myeloma]] and will exhibit any of the following features:<ref name="SergentanisZagouri2015">{{cite journal|last1=Sergentanis|first1=Theodoros N.|last2=Zagouri|first2=Flora|last3=Tsilimidos|first3=Gerasimos|last4=Tsagianni|first4=Anastasia|last5=Tseliou|first5=Melina|last6=Dimopoulos|first6=Meletios A.|last7=Psaltopoulou|first7=Theodora|title=Risk Factors for Multiple Myeloma: A Systematic Review of Meta-Analyses|journal=Clinical Lymphoma Myeloma and Leukemia|volume=15|issue=10|year=2015|pages=563–577.e3|issn=21522650|doi=10.1016/j.clml.2015.06.003}}</ref>
**[[M protein]] in blood or urine
**[[Bone marrow cells|Bone marrow]] [[plasma cells]] constitute more than 10% of the [[blood cells]]
**Presence of solitary [[plasmacytoma]] in bone
**≥ 1 myeloma-defining event
**CRAB features ( explained above)
**Osteolytic lesions on bone x-ray
 
*Patients with active [[multiple myeloma]] usually require treatment to prevent progression of disease which can lead to death.
 
====Smoldering multiple myeloma====
 
*It is asymptomatic type of [[Multiple myeloma classification|multiple myeloma]].<ref name="pmid27291302">{{cite journal |vauthors=Rajkumar SV |title=Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management |journal=Am. J. Hematol. |volume=91 |issue=7 |pages=719–34 |date=July 2016 |pmid=27291302 |pmc=5291298 |doi=10.1002/ajh.24402 |url=}}</ref>
*Shows presence of M-spike that quantitates > 3 g/dl on [[protein electrophoresis]].
 
*Presence of [[Bone marrow cells|bone marrow plasma cell]] burden of > 10% but < 60%.
 
*Absence of end-organ damage such as [[anemia]], [[hypercalcemia]], [[Renal dysfunction|renal dysfunction,]] or [[Osseous|osseous lesions]].
 
*Patients with smoldering (asymptomatic) [[multiple myeloma]] are managed by observation and undergoing follow up tests every 3 to 6 months.
*There is high risk of developing active [[multiple myeloma]].
 
====Plasma-cell leukemia====


* [[Nephrotic syndrome]]
*Characterized by large number of [[plasma cells]] circulating in the blood.<ref name="Rajkumar2016" />
* [[Restrictive cardiomyopathy]]
*Rare condition, can develop in to most aggressive form of [[Multiple myeloma Classification|multiple myeloma]].
* [[Peripheral neuropathy]]
*Can occur as a secondary type in a patient with multiple myeloma.
* [[Hepatomegaly]] with elevated [[liver enzymes]]
*Treatment options for [[plasma cell leukemia]] is [[chemotherapy]] or [[Hematopoietic stem cell transplantation|stem cell transplant]].
* [[Macroglossia]]
 
* [[Purpura]] and an unexplained [[Hemorrhagic diathesis|bleeding diathesis]]  
====Non-secretory myeloma====
|}
 
[[Category:Projects]]
*Type of [[Multiple myeloma classification|multiple myeloma]] with less amount of [[M protein|M proteins]] secretion in [[blood]] or urine.<ref name="Rajkumar2016" />
[[Category:Help]]
*M protein is not detected by [[serum protein electrophoresis]].
*[[Bone marrow]] exibit [[Myeloma|myeloma cells]].
*Osteolytic bone lesions are seen on X-ray.
 
====IgD myeloma====
 
*IgD type constitues 2% of [[Multiple myeloma Classification|multiple myeloma]].<ref name="Rajkumar2016" />
*IgD [[Multiple myeloma classification|multiple myeloma]] has similar signs and symptoms as other types of [[Multiple myeloma classification|multiple myeloma]].
 
*IgD myeloma mostly affect people of younger age.


Myeloma defining events: >60% clonal plasma cells on B.M exam; serum involved:uninvolved FLC ratio >100; >1 focal lesion on MRI >5mm
====Osteosclerotic myeloma====


CRAB features: elevated calcium >11mg/dl, renal insufficiency, '''a'''nemia Hb <10 g/dL , bone disease ≥1 lytic lesions on skeletal radiography, CT, or PET-CT , SFLC: serum free light chains, kappa and lambda immunoglobulin light chains.
*It is a rare disorder affecting multiple systems of the body.<ref name="Rajkumar2016">{{cite journal|last1=Rajkumar|first1=S. Vincent|title=Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management|journal=American Journal of Hematology|volume=91|issue=7|year=2016|pages=719–734|issn=03618609|doi=10.1002/ajh.24402}}</ref>


The normal κ:λ ratio is 0.26 to 1.65 (17,18). A κ:λ ratio of <0.26 strongly suggests the presence of a  of plasma cells that are producing clonal λ free light chains. Ratio >1.65 suggests production of clonal κ free light chains.
*It is called POEMS syndrome: [[polyneuropathy]], [[Organomegaly|organomegaly,]] [[endocrinopathy]], monoclonal protein, skin changes.
*Treatment option for osteoclastic myeloma include:
**[[Chemotherapy]]
**[[Radiation therapy]]
**[[Hematopoietic stem cell transplantation|Stem cell transplant]]


== Plasma cell disorders ==
====Solitary plasmacytoma of bone====


=== Monoclonal gammopathies of undetermined significance (MGUS) ===
*[[Plasmacytoma]] is collection of abnormal [[plasma cells]] forming a single tumor.<ref name="CaersPaiva2018">{{cite journal|last1=Caers|first1=J.|last2=Paiva|first2=B.|last3=Zamagni|first3=E.|last4=Leleu|first4=X.|last5=Bladé|first5=J.|last6=Kristinsson|first6=S. Y.|last7=Touzeau|first7=C.|last8=Abildgaard|first8=N.|last9=Terpos|first9=E.|last10=Heusschen|first10=R.|last11=Ocio|first11=E.|last12=Delforge|first12=M.|last13=Sezer|first13=O.|last14=Beksac|first14=M.|last15=Ludwig|first15=H.|last16=Merlini|first16=G.|last17=Moreau|first17=P.|last18=Zweegman|first18=S.|last19=Engelhardt|first19=M.|last20=Rosiñol|first20=L.|title=Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel|journal=Journal of Hematology & Oncology|volume=11|issue=1|year=2018|issn=1756-8722|doi=10.1186/s13045-017-0549-1}}</ref>
* Monoclonal gammopathy of undetermined significance is a condition in which a low or non-quantifiable level of a [[monoclonal]] [[paraprotein]] is detected in the blood by means of [[protein electrophoresis]].<ref name="pmid16628189">{{cite journal |vauthors=Jego G, Bataille R, Geffroy-Luseau A, Descamps G, Pellat-Deceunynck C |title=Pathogen-associated molecular patterns are growth and survival factors for human myeloma cells through Toll-like receptors |journal=Leukemia |volume=20 |issue=6 |pages=1130–7 |date=June 2006 |pmid=16628189 |doi=10.1038/sj.leu.2404226 |url=}}</ref><ref name="pmid19181642">{{cite journal |vauthors=Dinarello CA |title=Targeting the pathogenic role of interleukin 1{beta} in the progression of smoldering/indolent myeloma to active disease |journal=Mayo Clin. Proc. |volume=84 |issue=2 |pages=105–7 |date=February 2009 |pmid=19181642 |pmc=2664579 |doi=10.4065/84.2.105 |url=}}</ref><ref name="pmid23233640">{{cite journal |vauthors=Merlini G, Palladini G |title=Differential diagnosis of monoclonal gammopathy of undetermined significance |journal=Hematology Am Soc Hematol Educ Program |volume=2012 |issue= |pages=595–603 |date=2012 |pmid=23233640 |doi=10.1182/asheducation-2012.1.595 |url=}}</ref>
*[[Plasmacytoma|Solitary plasmacytoma]] is occurrence of single bone [[tumor]] made up of myeloma cells.
* In addition, some patients develop a [[polyneuropathy]] (damage to peripheral nerves) or other problems related to the secreted antibody. MGUS is distinct from [[multiple myeloma]].
*X-ray shows an osteolytic lesion at the site of the [[Tumor|tumor.]]
* Pathologically, the lesion in [[Monoclonal gammopathy of undetermined significance]] is in fact very similar to that in [[multiple myeloma]].
*[[Bone marrow]] plasma population remains less than 10%.
For more information about Monoclonal gammopathies of undetermined significance  '''[[Monoclonal gammopathies of undetermined significance |click here]]'''
*One third of patients with solitary [[plasmacytoma]] will develop [[Multiple myeloma classification|multiple myeloma]].


=== Malignant monoclonal gammopathies ===
====Extramedullary plasmacytoma====


==== '''Multiple myeloma''' ====
*It is developed outside the [[bone marrow]] in soft tissues of the body<ref name="Rajkumar2016" />
*Most commonly seen in throat, [[paranasal sinuses]], [[nasal cavity]], [[larynx]], [[Gastrointestinal tract|GI tract,]] [[breast]], and [[brain]].
*Diagnosis is confirmed by [[biopsy]] of the [[Tumor|tumor.]]
*X-rays and [[bone marrow]] [[biopsy]] is normal.
*Treatment is done with either [[radiation therapy]] or surgery.


===== Symptomatic [[multiple myeloma]] =====
For more information about [[multiple myeloma]], '''[[Multiple myeloma |click here]].'''
* People with multiple myeloma with symptoms are categorized to have active multiple myeloma and will exibit any of the following features.<ref name="SergentanisZagouri2015">{{cite journal|last1=Sergentanis|first1=Theodoros N.|last2=Zagouri|first2=Flora|last3=Tsilimidos|first3=Gerasimos|last4=Tsagianni|first4=Anastasia|last5=Tseliou|first5=Melina|last6=Dimopoulos|first6=Meletios A.|last7=Psaltopoulou|first7=Theodora|title=Risk Factors for Multiple Myeloma: A Systematic Review of Meta-Analyses|journal=Clinical Lymphoma Myeloma and Leukemia|volume=15|issue=10|year=2015|pages=563–577.e3|issn=21522650|doi=10.1016/j.clml.2015.06.003}}</ref>
** M protein in blood or urine
** Bone marrow plasma cells constitute more than 10% of the blood cells
** Presence of solitary plasmacytoma in bone
** ≥1 myeloma-defining event
** CRAB features ( explained above)
** Osteolytic lesions on bone x-ray


* Patients with active [[Multiple myeloma diagnostic criteria|Multiple myeloma]] usually require treatment to prevent progression of disease which can lead to death.
===Malignant lymphoproliferative disorders===
====Waldenstrom macroglobulinemia====


===== Smoldering multiple myeloma =====
*[[Waldenström's macroglobulinemia|Waldenstrom macroglobulinemia]] is a cancer involving [[lymphocytes]].<ref name="pmid22773606">{{cite journal |vauthors=Braggio E, Philipsborn C, Novak A, Hodge L, Ansell S, Fonseca R |title=Molecular pathogenesis of Waldenstrom's macroglobulinemia |journal=Haematologica |volume=97 |issue=9 |pages=1281–90 |date=September 2012 |pmid=22773606 |pmc=3436227 |doi=10.3324/haematol.2012.068478 |url=}}</ref>
* It is asymptomatic type of multiple myeloma<ref name="pmid27291302">{{cite journal |vauthors=Rajkumar SV |title=Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management |journal=Am. J. Hematol. |volume=91 |issue=7 |pages=719–34 |date=July 2016 |pmid=27291302 |pmc=5291298 |doi=10.1002/ajh.24402 |url=}}</ref>
*The main attributing [[antibody]] is [[IgM]].
* Shows presence of M-spike that quantitates > 3 g/dl on [[protein electrophoresis]]
*It is a type of [[lymphoproliferative disease]].
*It shares clinical characteristics with the indolent [[Non-Hodgkin lymphoma|non-Hodgkin lymphomas]].
*[[Waldenström's macroglobulinemia|Waldenstrom macroglobulinemia]] represents 1% of all hematological cancers.
*Common causes of [[Waldenström's macroglobulinemia]] include [[genetic]], environmental, and [[autoimmune]] factors.
*Common [[risk factors]] in the development of [[Waldenström's macroglobulinemia]] are [[monoclonal gammopathies of undetermined significance]].


* Presence of bone marrow plasma cell burden of > 10% but < 60%
For more information about [[Waldenström's macroglobulinemia]], '''[[Waldenström's macroglobulinemia |click here]].'''


* Absence of end-organ damage such as anemia, [[hypercalcemia]], renal dysfunction, or [[Osseous|osseous lesions]]
====Malignant lymphoma====


* Patients with smoldering (asymptomatic) [[Multiple myeloma diagnostic criteria|Multiple myeloma]] are managed by observation and undergoing follow up tests every 3 to 6 months
*Type of [[cancer]] that originates in [[Lymphocyte|lymphocytes]].<ref name="isbn92-832-2411-6">{{cite book |author= |title=Pathology and Genetics of Haemo (World Health Organization Classification of Tumours S.) |publisher=Oxford Univ Pr |location= |year= |pages= |isbn=92-832-2411-6 |oclc= |doi=}}</ref>
* There is high risk of developing active multiple myeloma.
*Also called [[Hematological malignancy|hematological neoplasms]].
*Primary types include [[Hodgkin lymphoma]] and [[non-Hodgkin lymphoma]].


===== Plasma-cell leukemia =====
For more information about [[malignant lymphoma]], '''[[lymphoma |click here]].'''
* Charecterized by large number of plasma cells circulating in the blood<ref name="Rajkumar2016" />
* Rare condition, can develop in to most aggressive form of multiple myeloma.
* Treatment options for plasma cell leukemia is chemotherapy or stem cell transplant.


===== Non-secretory myeloma =====
===Chronic lymphocytic leukemia===
* Type of multiple myeloma with less amount of M proteins secretion in blood or urine.<ref name="Rajkumar2016" />
* M protein is not detected by protein electrophoresis
* Bone marrow exibit myeloma cells.
* Osteolytic bone lesions are seen on xrays.


===== IgD myeloma =====
*[[Chronic lymphocytic leukemia]] arises from pre-follicular center [[B cell|B cells]], normally involved in [[Immunoglobulin|immunoglobulins]] production.<ref name="Hallek2015">{{cite journal|last1=Hallek|first1=Michael|title=Chronic lymphocytic leukemia: 2015 Update on diagnosis, risk stratification, and treatment|journal=American Journal of Hematology|volume=90|issue=5|year=2015|pages=446–460|issn=03618609|doi=10.1002/ajh.23979}}</ref>
* IgD type constitues 2% of multiple myeloma<ref name="Rajkumar2016" />
*Development of [[chronic lymphocytic leukemia]] is the result of multiple [[Genetic mutation|genetic mutations]] that promote both [[malignant]] leukemic proliferation and [[apoptotic]] resistance of mature [[B cells]].
* IgD multiple myeloma has similar signs and symptoms as other types of multiple myeloma.
*[[Chronic lymphocytic leukemia]] must be differentiated from [[hairy cell leukaemia]], prolymphocytic leukaemia, [[follicular lymphoma]], and [[mantle cell lymphoma]].
*[[Prognosis]] is generally good, and the 5-year survival rate of patients with [[chronic lymphocytic leukemia]] is approximately 81.7%.
*The mainstay of therapy for [[symptomatic]] [[chronic lymphocytic leukemia]] patients is immunochemotherapy.


* IgD myeloma mostly affect people of younger age.
For more information about [[chronic lymphocytic leukemia]], '''[[ chronic lymphocytic leukemia|click here]]'''


===== Osteosclerotic myeloma =====
==Heavy-chain diseases (HCD)==
* It is a rare disorder affecting multiple systems of the body<ref name="Rajkumar2016">{{cite journal|last1=Rajkumar|first1=S. Vincent|title=Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management|journal=American Journal of Hematology|volume=91|issue=7|year=2016|pages=719–734|issn=03618609|doi=10.1002/ajh.24402}}</ref>


* It is called POEMS syndrome: polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes
*Heavy chain diseases are [[plasma cell]] [[neoplasia]] featuring overproduction of [[Immunoglobulin|immunoglobulin heavy chains]].<ref name="MunshiCabot2008">{{cite journal|last1=Munshi|first1=Nikhil C.|last2=Cabot|first2=Richard C.|last3=Harris|first3=Nancy Lee|last4=Shepard|first4=Jo-Anne O.|last5=Rosenberg|first5=Eric S.|last6=Cort|first6=Alice M.|last7=Ebeling|first7=Sally H.|last8=Peters|first8=Christine C.|last9=Digumarthy|first9=Subba|last10=Rahemtullah|first10=Aliyah|title=Case 13-2008|journal=New England Journal of Medicine|volume=358|issue=17|year=2008|pages=1838–1848|issn=0028-4793|doi=10.1056/NEJMcpc0800959}}</ref>
* Treatment option for osteoclastic myeloma include:
** Chemotherapy
** Radiation therapy
** Stem cell transplant


===== Solitary plasmacytoma of bone =====
===γHCD===
* Plasmacytoma is collection of abnormal plasma cells forming a singl e tumor.<ref name="CaersPaiva2018">{{cite journal|last1=Caers|first1=J.|last2=Paiva|first2=B.|last3=Zamagni|first3=E.|last4=Leleu|first4=X.|last5=Bladé|first5=J.|last6=Kristinsson|first6=S. Y.|last7=Touzeau|first7=C.|last8=Abildgaard|first8=N.|last9=Terpos|first9=E.|last10=Heusschen|first10=R.|last11=Ocio|first11=E.|last12=Delforge|first12=M.|last13=Sezer|first13=O.|last14=Beksac|first14=M.|last15=Ludwig|first15=H.|last16=Merlini|first16=G.|last17=Moreau|first17=P.|last18=Zweegman|first18=S.|last19=Engelhardt|first19=M.|last20=Rosiñol|first20=L.|title=Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel|journal=Journal of Hematology & Oncology|volume=11|issue=1|year=2018|issn=1756-8722|doi=10.1186/s13045-017-0549-1}}</ref>
* Solitary plasmacytoma is occurence of single bone tumor made up of myeloma cells.
* Xray shows an osteolytic lesion at the site of the tumor.
* Bone marrow plasma population remains less than 10%
* One third of patients with solitary plasmacytoma will develop multiple myeloma.


===== Extramedullary plasmacytoma =====
*Also known as gamma chain or IgG heavy chain disease.
* It is develped outside the bone marrow in soft tissues of the body<ref name="Rajkumar2016" />
**Primarily seen in elderly men but can occur in children.
* Most commonly seen in throat,paranasal sinuses, nasal cavity, larynx,GI tract, breast and brain.
**High levels of IgG with reduction of normal [[immunoglobulin]] level.
* Diagnosis is confirmed by biopsy of the tumor.
**[[Lymphadenopathy|Lymphadenopath]]<nowiki/>y, [[hepatosplenomegaly]], and recurrent infections are common features.
* X-rays and bone marrow biopsy is normal.
**[[Vincristine]], [[Corticosteroid|corticosteroids]] and [[radiation therapy]] may produce [[Remission (medicine)|remission]].
* Treatment is done with either radiation therapy or surgry.
For more information about Multiple myeloma '''[[Multiple myeloma |click here]]'''


==== '''Malignant lymphoproliferative disorders''' ====
===αHCD===
* [[Waldenström's macroglobulinemia|Waldenstrom macroglobulinemia]]<ref name="pmid22773606">{{cite journal |vauthors=Braggio E, Philipsborn C, Novak A, Hodge L, Ansell S, Fonseca R |title=Molecular pathogenesis of Waldenstrom's macroglobulinemia |journal=Haematologica |volume=97 |issue=9 |pages=1281–90 |date=September 2012 |pmid=22773606 |pmc=3436227 |doi=10.3324/haematol.2012.068478 |url=}}</ref>
** [[Waldenström's macroglobulinemia|Waldenstrom macroglobulinemia]] is a cancer involving  [[lymphocytes]].
** The main attributing [[antibody]] is [[IgM]].
** It is a type of [[lymphoproliferative disease]],
** It shares clinical characteristics with the indolent [[Non-Hodgkin lymphoma|non-Hodgkin lymphomas]].
** [[Waldenström's macroglobulinemia|Waldenstrom macroglobulinemia]] represents 1% of all hematological cancers
** Common causes of [[Waldenström's macroglobulinemia]] include [[genetic]], environmental, and [[autoimmune]] factors.
** Common [[risk factors]] in the development of [[Waldenström's macroglobulinemia]] are [[Monoclonal gammopathy of undetermined significance]]. For more information about Waldenström's macroglobulinemia  '''[[Waldenström's macroglobulinemia |click here]]'''


====== Malignant lymphoma ======
*Also known as alpha chain or IgA heavy chain.
* Type of [[cancer]] that originates in [[Lymphocyte|lymphocytes]]<ref name="isbn92-832-2411-6">{{cite book |author= |title=Pathology and Genetics of Haemo (World Health Organization Classification of Tumours S.) |publisher=Oxford Univ Pr |location= |year= |pages= |isbn=92-832-2411-6 |oclc= |doi=}}</ref>
**Appears between age 10-30 as an [[immune]] response to a [[microorganism]].
* Also called [[Hematological malignancy|hematological neoplasms]].  
**Patients present with diffuse abdominal [[lymphoma]] and [[malabsorption]].
* Main types are Hodgkin lymphoma and Non-Hodgkin lymphoma
**Course is variable, some patients die in 1-2 yrs, others go in to [[Remission (medicine)|remission]] lasting for many years.
For more information about lymphoma '''[[lymphoma |click here]]'''
**[[Serum protein electrophoresis]] detect increased α & β fraction.
**Treatment is [[Corticosteroid|corticosteroids]], [[cytotoxic drugs]] and broadspectrum antibiotics


=== Chronic lymphocytic leukemia ===
===μHCD===
* [[Chronic lymphocytic leukemia]] arises from pre-follicular center [[B cell|B cells]], normally involved in [[Immunoglobulin|immunoglobulins]] production.<ref name="Hallek2015">{{cite journal|last1=Hallek|first1=Michael|title=Chronic lymphocytic leukemia: 2015 Update on diagnosis, risk stratification, and treatment|journal=American Journal of Hematology|volume=90|issue=5|year=2015|pages=446–460|issn=03618609|doi=10.1002/ajh.23979}}</ref>
* Development of [[chronic lymphocytic leukemia]] is the result of multiple [[Genetic mutation|genetic mutations]] that promote both [[malignant]] leukemic proliferation and [[apoptotic]] resistance of mature [[B cells]].
* [[Chronic lymphocytic leukemia]] must be differentiated from [[hairy cell leukaemia]], prolymphocytic leukaemia, [[follicular lymphoma]], and [[mantle cell lymphoma]].
* Prognosis is generally good, and the 5-year survival rate of patients with [[chronic lymphocytic leukemia]] is approximately 81.7%.
* The mainstay of therapy for symptomatic [[chronic lymphocytic leukemia]] patients is immunochemotherapy.
For more information about chronic lymphocytic leukemia '''[[ chronic lymphocytic leukemia|click here]]'''


=== Heavy-chain diseases ===
*Also known as mu chain or IGM heavy chain disease.
Heavy chain diseases are plasma cell neoplasias, featuring overproduction of immunoglobulin heavy chains.
**Mainly affects individuals > 50 yrs.
**[[Spleen]], [[liver]] and abdominal [[lymph nodes]] involvement is more common than peripheral [[lymphadenopathy]].
**[[Serum]] [[protein electrophoresis]] exibit [[hypogammaglobulinemia]].
**Vacuolated [[Plasma cell|plasma cells]] are pathognomic on [[bone marrow]] exam.
**Treatment consists of [[Alkylating agent|alkylating agents]] and [[Corticosteroid|corticosteroids]].


==== γHCD ====
==Cryoglobulinemia==
Gamma chain or IgG heavy chain disease
* Primarily seen in elderly men but can occur in children.
* High levels of IgG with reduction of normal immunoglobulin level
* Lymphadenopathy, hepatosplenomegaly and recurrent infections are common features
* Vincristine, corticosteroids and radiation therapy may produce remission.


==== αHCD ====
*[[Cryoglobulinemia]] is the presence of high amount of heavy [[Globulin|globulins]] (e.g. [[IgM]]) in the [[bloodstream]] which thicken on exposure to cold.<ref name="pmid16026843">{{cite journal| author=Scotto G, Cibelli DC, Saracino A, Prato R, Palumbo E, Fazio V et al.| title=Cryoglobulinemia in subjects with HCV infection alone, HIV infection and HCV/HIV coinfection. | journal=J Infect | year= 2006 | volume= 52 | issue= 4 | pages= 294-9 | pmid=16026843 | doi=10.1016/j.jinf.2005.05.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16026843  }} </ref><ref name="pmid29558353">{{cite journal| author=Suszek D, Majdan M| title=[Cryoglobulins and cryoglobulinemic vasculitis]. | journal=Wiad Lek | year= 2018 | volume= 71 | issue= 1 pt 1 | pages= 59-63 | pmid=29558353 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29558353  }} </ref><ref name="pmid27034078">{{cite journal| author=Blank N, Lorenz HM| title=[Cryoglobulinemic vasculitis]. | journal=Z Rheumatol | year= 2016 | volume= 75 | issue= 3 | pages= 303-15 | pmid=27034078 | doi=10.1007/s00393-016-0076-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27034078  }} </ref><ref name="pmid10787003">{{cite journal| author=Ramos-Casals M, Trejo O, García-Carrasco M, Cervera R, Font J| title=Mixed cryoglobulinemia: new concepts. | journal=Lupus | year= 2000 | volume= 9 | issue= 2 | pages= 83-91 | pmid=10787003 | doi=10.1191/096120300678828127 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10787003  }} </ref>
Alpha chain or IgA heavy chain
*Cryoglobulins are circulating [[immunoglobulins]] or [[Protein|proteins]] that become insoluble at less than 4 degrees celsius.
* Appears between age 10-30 as an immune response to a microorganism
*[[Cryoglobulinemia]] can lead to a medium-sized vessel [[vasculitis]] due to vascular deposition of circulating [[immune complexes]].
* Patients present with diffuse abdominal lymphoma and malabsorption.
*This leads to the triad of palpable [[purpura]], [[Arthralgia|arthralgias]] and [[peripheral neuropathy]].
* Course is variable, some patients die in 1-2 yrs, others go in to remission lasting for many years.
*Common causes of [[Cryoglobulinemia CT|cryoglobulinemia]] are primarily [[hematologic]], [[Oncology|oncologic]], and [[rheumatic]]
* Serum protein electrophoresis detect increased α & β fraction.
* Treatment is corticosteroids, cytotoxic drugs and broadspectrum antibiotics


==== μHCD ====
For more information on [[cryoglobulinemia]], [[Cryoglobulinaemia|'''click here''']].
MU chain or IGM heavy chain disease
* Mainly affects individuals > 50 yrs
* Spleen, liver and abdominal lymph nodes involvement is more common than peripheral lymphadenopathy
* Serum protein electrophoresis exibit hypogammaglobulinemia.
* Vacuolated plasma cells are pathognomic on bone marrow exam.
* Treatment consists of alkylating agents and corticosteroids.


=== Cryoglobulinemia ===
==Primary amyloidosis==
* [[Cryoglobulinemia]] is the presence of high amount of heavy [[Globulin|globulins]] (e.g. [[IgM]]) in the [[bloodstream]] which thicken on exposure to cold.<ref name="pmid16026843">{{cite journal| author=Scotto G, Cibelli DC, Saracino A, Prato R, Palumbo E, Fazio V et al.| title=Cryoglobulinemia in subjects with HCV infection alone, HIV infection and HCV/HIV coinfection. | journal=J Infect | year= 2006 | volume= 52 | issue= 4 | pages= 294-9 | pmid=16026843 | doi=10.1016/j.jinf.2005.05.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16026843  }} </ref><ref name="pmid29558353">{{cite journal| author=Suszek D, Majdan M| title=[Cryoglobulins and cryoglobulinemic vasculitis]. | journal=Wiad Lek | year= 2018 | volume= 71 | issue= 1 pt 1 | pages= 59-63 | pmid=29558353 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29558353  }} </ref><ref name="pmid27034078">{{cite journal| author=Blank N, Lorenz HM| title=[Cryoglobulinemic vasculitis]. | journal=Z Rheumatol | year= 2016 | volume= 75 | issue= 3 | pages= 303-15 | pmid=27034078 | doi=10.1007/s00393-016-0076-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27034078  }} </ref><ref name="pmid10787003">{{cite journal| author=Ramos-Casals M, Trejo O, García-Carrasco M, Cervera R, Font J| title=Mixed cryoglobulinemia: new concepts. | journal=Lupus | year= 2000 | volume= 9 | issue= 2 | pages= 83-91 | pmid=10787003 | doi=10.1191/096120300678828127 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10787003  }} </ref>
* Cryoglobulins are circulating [[immunoglobulins]] or [[Protein|proteins]] that become insoluble at less than 4 degrees Celsius.
* Cryoglobulinemia can lead to a medium-sized vessel [[vasculitis]] due to vascular deposition of circulating [[immune complexes]].
* This leads to the triad of palpable [[purpura]], [[Arthralgia|arthralgias]] and [[peripheral neuropathy]]
* Common causes of cryoglobulinemia are primarily hematologic, oncologic, and rheumatic
For more information on Cryoglobulinemia [[Cryoglobulinemia| click here]]


=== Primary amyloidosis ===
*The "AL" refers to [[amyloid]] [[light chain]].<ref name="pmid15198347">{{cite journal |author=Gertz MA |title=The classification and typing of amyloid deposits |journal=Am. J. Clin. Pathol. |volume=121 |issue=6 |pages=787–9 |year=2004 |month=June |pmid=15198347 |doi=10.1309/TR4L-GLVR-JKAM-V5QT |url=http://ajcp.metapress.com/openurl.asp?genre=article&issn=0002-9173&volume=121&issue=6&spage=787}}</ref><ref name="urlAmyloidosis Causes, Diagnosis, Symptoms, and Treatment on MedicineNet.com">{{cite web |url=http://www.medicinenet.com/amyloidosis/article.htm |title=Amyloidosis Causes, Diagnosis, Symptoms, and Treatment on MedicineNet.com |format= |work= |accessdate=}}</ref>
The "AL" refers to [[amyloid]] light chain.<ref name="pmid15198347">{{cite journal |author=Gertz MA |title=The classification and typing of amyloid deposits |journal=Am. J. Clin. Pathol. |volume=121 |issue=6 |pages=787–9 |year=2004 |month=June |pmid=15198347 |doi=10.1309/TR4L-GLVR-JKAM-V5QT |url=http://ajcp.metapress.com/openurl.asp?genre=article&issn=0002-9173&volume=121&issue=6&spage=787}}</ref><ref name="urlAmyloidosis Causes, Diagnosis, Symptoms, and Treatment on MedicineNet.com">{{cite web |url=http://www.medicinenet.com/amyloidosis/article.htm |title=Amyloidosis Causes, Diagnosis, Symptoms, and Treatment on MedicineNet.com |format= |work= |accessdate=}}</ref>
**[[AL amyloidosis]] is the most common form of systemic [[amyloidosis]] in the US.
**Occurs in 5 to 15% of people with [[multiple myeloma]].
**Treatment can involve application of [[chemotherapy]] similar to that used in [[Multiple myeloma Classification|multiple myeloma]]


* AL amyloidosis is the most common form of systemic [[amyloidosis]] in the US.
For more information on primary amyloidosis, '''[[Primary amyloidosis|click here]].'''
* Occurs in 5 to 15% of people with [[multiple myeloma]].
* Treatment can involve application of [[chemotherapy]] similar to that used in multiple myeloma
For more information on amyloidosis [[ amyloidosis | click here]]


==References==
==References==
Line 344: Line 325:
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Medicine]]
[[Category:Hematology]]
[[Category:Oncology]]

Latest revision as of 11:52, 19 July 2022


Plasma cell disorders

Overview

Classification

Monoclonal gammopathy of undetermined significance (MGUS)
Malignant monoclonal gammopathies
Multiple myeloma
Malignant lymphoproliferative disorders
Chronic lymphocytic leukemia
Heavy-chain diseases
Cryoglobulinemia
Primary amyloidosis

Differentiating Plasma Cell Disorder

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nazia Fuad M.D., Anmol Pitliya, M.B.B.S. M.D.[2]

Synonyms and keywords: Plasma cell dyscrasia

Overview

Plasma cell disorders are a diverse type of blood disorders characterized by proliferation of a single clone of plasma cells that produces a homogeneous monoclonal (M) protein. These monoclonal paraprotein are seen in the serum or urine. Monoclonal plasma cells are present in the bone marrow or, rarely, in other tissues. Plasma cell disorders include monoclonal gammopathy of undetermined significance (MGUS), multiple myeloma (MM), lymphoplasmacytic lymphoma or Waldenstrom macroglobulinemia (LPL/WM), lymphoproliferative disorders, smoldering multiple myeloma (SMM); solitary or extramedullary plasmacytoma, amyloidosis, and POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes). These disorders have been defined by the International Myeloma Working Group in 2006.

Classification

 
 
 
 
 
 
 
 
 
 
 
Plasma cell disorder
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Primary amyloidosis
 
Malignant monoclonal gammopathy
 
Chronic lymphocytic leukemia
 
 
 
Heavy chain diseases (HCD)
 
Cryoglobulinemia
 
Monoclonal gammopathy of undetermined significance (MGUS)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Multiple myeloma
 
 
Malignant lymphoproliferative disorders
 
γHCD
 
αHCD
 
μHCD
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Benign
(IgG, IgA, IgD, IgM, and,
rarely, free light chains)
 
Associated neoplasms
or other diseases not known to
produce monoclonal proteins
 
Biclonal and triclonal
gammopathies
 
Idiopathic
(Bence Jones
proteinuria)
 
 
 
 
 
 
 
 
 
 
 
 
Waldenstrom macroglobulinemia
 
Malignant lymphoma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Symptomatic multiple myeloma
 
Smoldering multiple myeloma
 
Plasma-cell leukemia
 
Non-secretory myeloma
 
IgD myeloma
 
Osteosclerotic myeloma
 
Solitary plasmacytoma of bone
 
Extramedullary plasmacytoma
 

Differential Diagnosis

Disease IgM IgG IgA IgE IgD Monoclonal Ig level SFLC Bone marrow plasma cells Other criteria
IgM MGUS + < 3gm/dl N/A <10%
  • No end-organ damage
Non igM MGUS + + < 3gm/dl N/A <10%
  • No end-organ damage
Smoldering MM + + > 3gm/dl N/A 10-60%
  • No myeloma-defining event
  • No CRAB features
Light chain MGUS <500 mg/24 hrs (urine) Free kappa or lambda light chain
Abnormal ratio (<0.26 or >1.65)
Increase in involved light chain concentration
<10%
  • No end-organ damage
Active symptomatic Multiple myeloma + + + + >3gm/dl >100 >60%
  • ≥1 myeloma-defining event
  • CRAB features
Waldenstrom macroglobulinemia + Variable N/A >10%
Solitary Plasmacytoma + <3mg/dl Abnormal in 47% cases Normal
Primary amyloidosis <3md/dl Light chains of immunoglobulines <10%
  • Myeloma defining events: >60% clonal plasma cells on B.M exam; serum involved: uninvolved FLC ratio >100; >1 focal lesion on MRI >5mm
  • CRAB features: elevated calcium >11mg/dl, renal insufficiency, anemia Hb <10 g/dL , bone disease ≥1 lytic lesions on skeletal radiography, CT, or PET-CT , SFLC: serum free light chains, kappa and lambda immunoglobulin light chains.
  • The normal κ:λ ratio is 0.26 to 1.65 (17,18). A κ:λ ratio of <0.26 strongly suggests the presence of a of plasma cells that are producing clonal λ free light chains. Ratio >1.65 suggests production of clonal κ free light chains.

Monoclonal gammopathies of undetermined significance (MGUS)

For more information about monoclonal gammopathies of undetermined significance click here.

Malignant monoclonal gammopathies

Multiple myeloma

Symptomatic multiple myeloma

  • Patients with active multiple myeloma usually require treatment to prevent progression of disease which can lead to death.

Smoldering multiple myeloma

  • Patients with smoldering (asymptomatic) multiple myeloma are managed by observation and undergoing follow up tests every 3 to 6 months.
  • There is high risk of developing active multiple myeloma.

Plasma-cell leukemia

Non-secretory myeloma

IgD myeloma

  • IgD myeloma mostly affect people of younger age.

Osteosclerotic myeloma

  • It is a rare disorder affecting multiple systems of the body.[6]

Solitary plasmacytoma of bone

Extramedullary plasmacytoma

For more information about multiple myeloma, click here.

Malignant lymphoproliferative disorders

Waldenstrom macroglobulinemia

For more information about Waldenström's macroglobulinemia, click here.

Malignant lymphoma

For more information about malignant lymphoma, click here.

Chronic lymphocytic leukemia

For more information about chronic lymphocytic leukemia, click here

Heavy-chain diseases (HCD)

γHCD

αHCD

μHCD

Cryoglobulinemia

For more information on cryoglobulinemia, click here.

Primary amyloidosis

For more information on primary amyloidosis, click here.

References

  1. Jego G, Bataille R, Geffroy-Luseau A, Descamps G, Pellat-Deceunynck C (June 2006). "Pathogen-associated molecular patterns are growth and survival factors for human myeloma cells through Toll-like receptors". Leukemia. 20 (6): 1130–7. doi:10.1038/sj.leu.2404226. PMID 16628189.
  2. Dinarello CA (February 2009). "Targeting the pathogenic role of interleukin 1{beta} in the progression of smoldering/indolent myeloma to active disease". Mayo Clin. Proc. 84 (2): 105–7. doi:10.4065/84.2.105. PMC 2664579. PMID 19181642.
  3. Merlini G, Palladini G (2012). "Differential diagnosis of monoclonal gammopathy of undetermined significance". Hematology Am Soc Hematol Educ Program. 2012: 595–603. doi:10.1182/asheducation-2012.1.595. PMID 23233640.
  4. Sergentanis, Theodoros N.; Zagouri, Flora; Tsilimidos, Gerasimos; Tsagianni, Anastasia; Tseliou, Melina; Dimopoulos, Meletios A.; Psaltopoulou, Theodora (2015). "Risk Factors for Multiple Myeloma: A Systematic Review of Meta-Analyses". Clinical Lymphoma Myeloma and Leukemia. 15 (10): 563–577.e3. doi:10.1016/j.clml.2015.06.003. ISSN 2152-2650.
  5. Rajkumar SV (July 2016). "Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management". Am. J. Hematol. 91 (7): 719–34. doi:10.1002/ajh.24402. PMC 5291298. PMID 27291302.
  6. 6.0 6.1 6.2 6.3 6.4 Rajkumar, S. Vincent (2016). "Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management". American Journal of Hematology. 91 (7): 719–734. doi:10.1002/ajh.24402. ISSN 0361-8609.
  7. Caers, J.; Paiva, B.; Zamagni, E.; Leleu, X.; Bladé, J.; Kristinsson, S. Y.; Touzeau, C.; Abildgaard, N.; Terpos, E.; Heusschen, R.; Ocio, E.; Delforge, M.; Sezer, O.; Beksac, M.; Ludwig, H.; Merlini, G.; Moreau, P.; Zweegman, S.; Engelhardt, M.; Rosiñol, L. (2018). "Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel". Journal of Hematology & Oncology. 11 (1). doi:10.1186/s13045-017-0549-1. ISSN 1756-8722.
  8. Braggio E, Philipsborn C, Novak A, Hodge L, Ansell S, Fonseca R (September 2012). "Molecular pathogenesis of Waldenstrom's macroglobulinemia". Haematologica. 97 (9): 1281–90. doi:10.3324/haematol.2012.068478. PMC 3436227. PMID 22773606.
  9. Pathology and Genetics of Haemo (World Health Organization Classification of Tumours S.). Oxford Univ Pr. ISBN 92-832-2411-6.
  10. Hallek, Michael (2015). "Chronic lymphocytic leukemia: 2015 Update on diagnosis, risk stratification, and treatment". American Journal of Hematology. 90 (5): 446–460. doi:10.1002/ajh.23979. ISSN 0361-8609.
  11. Munshi, Nikhil C.; Cabot, Richard C.; Harris, Nancy Lee; Shepard, Jo-Anne O.; Rosenberg, Eric S.; Cort, Alice M.; Ebeling, Sally H.; Peters, Christine C.; Digumarthy, Subba; Rahemtullah, Aliyah (2008). "Case 13-2008". New England Journal of Medicine. 358 (17): 1838–1848. doi:10.1056/NEJMcpc0800959. ISSN 0028-4793.
  12. Scotto G, Cibelli DC, Saracino A, Prato R, Palumbo E, Fazio V; et al. (2006). "Cryoglobulinemia in subjects with HCV infection alone, HIV infection and HCV/HIV coinfection". J Infect. 52 (4): 294–9. doi:10.1016/j.jinf.2005.05.025. PMID 16026843.
  13. Suszek D, Majdan M (2018). "[Cryoglobulins and cryoglobulinemic vasculitis]". Wiad Lek. 71 (1 pt 1): 59–63. PMID 29558353.
  14. Blank N, Lorenz HM (2016). "[Cryoglobulinemic vasculitis]". Z Rheumatol. 75 (3): 303–15. doi:10.1007/s00393-016-0076-4. PMID 27034078.
  15. Ramos-Casals M, Trejo O, García-Carrasco M, Cervera R, Font J (2000). "Mixed cryoglobulinemia: new concepts". Lupus. 9 (2): 83–91. doi:10.1191/096120300678828127. PMID 10787003.
  16. Gertz MA (2004). "The classification and typing of amyloid deposits". Am. J. Clin. Pathol. 121 (6): 787–9. doi:10.1309/TR4L-GLVR-JKAM-V5QT. PMID 15198347. Unknown parameter |month= ignored (help)
  17. "Amyloidosis Causes, Diagnosis, Symptoms, and Treatment on MedicineNet.com".

Template:WH Template:WS