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438 PART 6 ■ Neoplastic Disorders
FIGURE 22.18 V rious ppe r nces o pl s cells in
s e r o nor l bone rrow. A pro inent p le p r nu-
cle r zone n cytopl s ic v cuoles re seen in A n
B . T e cytopl s in C h s reticul r ppe r nce. T e
other cells in A re nonph gocytic reticul r cell n
l te polychro tic erythrobl st. (Reprinte ro Mills
SE. Histology or Pathologists, 3r e , Phil elphi , PA:
Lippincott Willi s & Wilkins, 2007, with per ission.)
ount o ree light ch ins th t were secrete s ono er
(k pp ) or i er (l b ).
Nephelo etric/turbi i etric qu ntif c tion o ree k pp
n light ch in h s reve le th t up to 20% o MM c ses
h ve ree light ch in-only ise se in which light ch ins in the
seru n /or urine re the only i unoche ic l bnor-
Monoclonal lity oun .
Treatment
T e role o ther py in both SC -eligible or SC -ineligible
Polyclonal yelo p tients is to chieve r pi , xi u rug
response with ini l toxicity.
Multiple yelo is incur ble with convention l
Normal che other py.
Melph l n-b se high- ose che other py with he -
topoietic ste cell support incre ses the r te o co plete
ALB α 1 α 2 β γ re ission n exten s event- ree n over ll surviv l. M ny
FIGURE 22.19 Abnor l seru protein electrophoretic p tterns p tients still experience rel pse, n options or s lv ge ther-
contr ste with nor l p ttern. Polyclon l hyperg globu- py re li ite .
line i , ch r cteristic o benign re ctive processes, shows bro - P tients with yelo who experience rel pse er
b se incre se in i unoglobulins, owing to i unoglobulin high- ose che other py h ve ew ther peutic options.
secretion by yri o re ctive pl s cells. Monoclon l g op - T li o i e, len li o i e, n bortezo ib re novel gents
thy o unknown signif c nce (MGUS) or pl s cell neopl si shows
n rrow pe k, or spike, owing to the ho ogeneity o the i unoglob- th t f rst e onstr te e c cy in tre ting rel pse n
ulin olecules secrete by single clone o berr nt pl s cells. ALB, re r ctory MM. Angiogenesis is i port nt in tu or progres-
lbu in. (Reprinte ro Rubin R, Str yer DS. Rubin’s Pathology: sion. As n i uno o ul tory rug, th li o i e inhibits
Clinicopathologic Foundations o Medicine, 5th e , Phil elphi , PA: ngiogenesis n in uces poptosis o cells in est blishe
Lippincott Willi s & Wilkins, 2008, with per ission.) neov scul ture.
