What are the different types of plasma cell disorders?

[Music] what are the different types of plasma cell disorders so there's a whole group of disorders that are related we call them plasma cell dyscrasia 'z and so what that represents our disorders of the plasma cell which is part of the normal immune system these are cells that normally make antibodies to fight infection and so when these cells start to go wrong when they start to become cancer or cancer like and start growing out of control they can form a variety of different disorders that we see clinically so one is what we call monoclonal gammopathy of undetermined significance this is something that's more common as people age we don't consider it a cancer in most people that never become something that we need to be concerned about and is is a disorder that rarely requires intervention but when someone has it we watch their proteins because those people are at higher risk of eventually developing some of the more significant problems like multiple myeloma and other plasma cell disorders multiple myeloma probably all patients go through a phase of monoclonal gammopathy of undetermined significance or what we call M Gus beforehand but it's never seen because it requires very specific testing multiple myeloma is the most common of the plasma cell disorders it comes in a variety of forms some people show up in what we call smoldering multiple myeloma which is they have multiple myeloma they have too many plasma cells inside their bone marrow in most of these patients we can see a protein floating in their blood which we call the monoclonal spike or the EM spike these patients at least routinely off of clinical trials don't require any specific therapy but patients who have smoldering myeloma are at very high risk of eventually developing active or symptomatic myeloma and those patients require therapy active myeloma is myeloma that requires therapy because we're seeing some evidence of damage to the organs and there are four major things we look for what we call the crab criteria and that's high calcium renal problems so kidney problems the a is anemia and then the B is bone lesions and when we have patients who have the meat criteria for active myeloma we we start those patients on chemotherapy of some sort there's another related disorder very rare called primary amyloidosis or light chain amyloidosis and this is also a disorder of the plasma cells in this case the problem is not so much the plasma cells themselves but the protein they make is actually forming deposits in various organs and this can lead to organ failure but in a different way than we see with patients who have myeloma so we can see heart failure kidney failure liver problems nerve problems pretty much any organ can be involved and it's very hard to make this diagnosis because it's so rare it really requires clinicians and often it's the primary care doctors to think about this disorder there's a related disorder that's sort of a mixture between a plasma cell disorder and a lymphoma called Waldenstrom's macroglobulinemia which also has another very difficult sounding name lympho plasma siddik lymphoma and these are cells that are sort of they look like a lymphoma cell and a myeloma cell had a baby and and these have a very specific genetic mutation they respond to very specific drugs and and in some people they may have the diagnosis of Waldenstrom's yet not require therapy and it can act as a smouldering version as well