1. MULTIPLE MYELOMA Dr. O.P.VermaM.B.B.S.,M.R.S.H.(London) President, Flax Awareness Society 7-B-43, Mahaveer Nagar III, Kota(Raj.) Visit us at http://flaxindia.blogspot.com E-mail dropvermaji@gmail.com +919460816360Disease Overview

2. 1|P age 1848 - - - ( ) , , , , , ... , (Thrombocytopenia) ... (Leucopenia) 3. 2|P age , - , - , - , M M -, 2 (heavy) 2 (light) M 20,000 1% 2% , 68-70 5 35% 2010 74000 - 1 % 2 % , (MGUS) , , , MGUS 10 4. 3|P age MGUS ( 1%) , , Parameter Monoclonal Proteins Bone marrow Plasma cells Treatment CRAB SymptomsMGUSSmouldering MyelomaMultiple Myeloma3 g>3 g< 10%>10%> 10%Wait & WatchWait & WatchChemo & Bonemarrow TransplantationNoNoHyperCalcemia >2.75 mmol/LRenal insufficiency Anemia (hemoglobin 177 mol/L) 13. 12 | P a g e 15 , , 2-3 10 , , , 65 -, - (ASCT) 14. 13 | P a g e 5-10 % , (complete remission) , 65 ( ) , , , , , (Oncovin) (Cytoxan) (VP-16) (Adriamycin) (Doxil) (Treanda) 15. 14 | P a g e ( ) ( ) ( ) Chemotherapy of Multiple Myeloma Primary therapy (transplant candidates) Bortezomib (Velcade)/Cyclophosphamide/Dexamethasone VCD Bortezomib/Dexamethasone Doxorubicin/Bortezomib/Dexamethasone DVD Bortezomib/Lenalidomide(Revlimid))/Dexamethasone Bortezomib/Thalidomide/Dexamethasone Lenalidomide/dexamethasonePrimary treatment (non-transplant candidates) Bortezomib/ Melphalan/Prednisone (VMP) Melphalan/ Prednisone/Thalidomide (MPT) Lenalidomide/Dexamethasone Bortezomib/Dexamethasone Melphalan/ prednisone (MP) Lenalidomide/ Melphalan and DexamethasoneTreatment recommendations for maintenance therapy Lenalidomide ThalidomideTreatment recommendations for salvage therapy Lenalidomide/Dexamethasone RD Pomalidomide Lenalidomide or Thalidomide , 16. 15 | P a g e (Thalomid) , , , (neuropathy) , (Revlimid) , , (Pomalyst) (Velcade) , 17. 16 | P a g e , , , , , , ( ) ( ) (Kyprolis) 4 , , , , , , , (Aredia) (Zometa) (ONJ) 3 % , (40 ,000 sc ) , 18. 17 | P a g e , , 2 ( 10 to 30 g/day) , , 1 10 3 ... -2 6 mg/L 54 6 mg/L 27 6 mg/L 6 ( >2 mg/dL ) (Conventional therapy) 3 , 2 50% 5 19. 18 | P a g e (30 , 1908 - 19 2003) , - ... 1923 . , 1931 , 1949 ( ) . , , , , 1952 . , , 89 7 20. 19 | P a g e .