FIGURE LEGENDS (from the top)

This chest X-ray shows a mass (blue arrowheads) induced by multiple myeloma. In addition, the disease has caused the destruction of the thoraic vertebra (red arrowhead).

This skull X-ray shows the punched out lesions (blue arrowheads) in the skull which are characteristic of multiple myeloma. The thickness of the bone has increased (red arrowhead).

The gross examination of the skull has revealed the lesions (arrowhead) induced by multiple myeloma.

Microscopic examination of the bone marrow smear reveals the abnormal plasma cells.

Multiple myeloma is a neoplastic disorder which results from hyperproliferation of plasma cells. This disease is the second most common malignancy of the hematopoietic system in the US. The plasma cells preferentially proliferate in the bone marrow and lead to the destruction of the bone. Such destruction produces characteristic radiolucent areas in the skull. The plasma cells secrete large amounts of a monoclonal antibody that is secreted into the peripheral circulation. The disease can be diagnosed by serum electrophoresis for showing the presence of the antibody. The disease can also be detected by showing light chains of the antibody in the urine (Bence Jones Protein). The cause of the disease is not known, however, it is thought that the IL-6 may act as a growth signal for the plasma cells and perpetuates the tumor growth. A virus from the herpesvirus family which is called herpesvirus 8 or Kaposi's Sarcoma-Associated Herpesvirus (KSHV) has been identified that within its genome carries a gene homolgous to the human IL-6. This viral IL-6 (vIL-6) exhibits a biologic activity similar to the human IL-6 and supports the growth of the plasmacytoma cell line, B9. Inspired by these findings, Rettig et al, searched for the KHSV in the DNA extracted from the stromal cells and mononuclear cells in the bone marrow. Despite the fact that the KHSV has not been identified in the malignant cells of myeloma, acute and chronic leukemias and Hodgkin's and Non-Hodghkin's lymphomas, Rettig et al, were able to demonstrate the presence of the KSHV in these cells. The KHSV was not detected in the bone marrow stromal cells in normal individuals and patients with other hematologic malignancies such as acute myelogenous leukemia, lymphoma and Hodgkin's disease and one patient with adenocarcinoma. In addition, the vIL-6 was detectable in the stromal cells of 3/3 patients with multiple myeloma. the vIL-6 was not detectable in the in the stromal cells of normal individuals. The KSHV was also detected in 2/8 patients with the monoclonal gammopathy of undetermined significance (MGUS) which is a precursor to the multiple myeloma. Based on this finding, the authors suggest that KSHV may be required for the transformation of the MGUS to the multiple myeloma.

REFERENCES:

Rainbow L, 1997           [See Related Articles]
The 222- to 234-kilodalton latent nuclear protein (LNA) of Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8) is encoded by orf73 and is a component of the latency-associated nuclear antigen.
J Virol 71(8), 5915-5921 (1997)

Simpson GR, 1996           [See Related Articles]
Prevalence of Kaposi's sarcoma associated herpesvirus infection measured by antibodies to recombinant capsid protein and latent immunofluorescence antigen Lancet 348(9035), 1133-1138 (1996)

Gao SJ, 1996           [See Related Articles]
KSHV antibodies among Americans, Italians and Ugandans with and without Kaposi's sarcoma Nat Med 2(8), 925-928 (1996)

Gao SJ, 1996           [See Related Articles]
Seroconversion to antibodies against Kaposi's sarcoma-associated herpesvirus-related latent nuclear antigens before the development of Kaposi's sarcoma. N Engl J Med 335(4), 233-241 (1996)

Miller G, 1996           [See Related Articles]
Antibodies to butyrate-inducible antigens of Kaposi's sarcoma-associated herpesvirus in patients with HIV-1 infection N Engl J Med 334(20), 1292-1297 (1996)

Moore PS, 1996           [See Related Articles]
Primary characterization of a herpesvirus agent associated with Kaposi's sarcomae J Virol 70(1), 549-558 (1996)

RESOURCES:

NCI Cancernet Facts sheets
CANCERNET (Information for patients) CANCERNET (Information for physicians)
CANCERNET(Bone marrow and Stem Cell Transplantation)
International Myeloma Foundation A support group for patients with myeloma
Multiple Myeloma Experience Exchange
Plasma Cell World - Hiroshima, Japan
Oncolink U Penn
Oncolink (Lymphomas and Myelomas)
Leukemia Society of America
THE Cancer FAQ

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