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Obesity is the most common known risk factor for MM. Be<strong>in</strong>g overweight or<br />

obese <strong>in</strong>creases a person’s risk of develop<strong>in</strong>g MM accord<strong>in</strong>g to a study carried out by<br />

the American Cancer Society (ACS, 2011).<br />

Other plasma cell diseases are also important risk factor for people, because<br />

these people most prone to get caught to MM. There is a crucial <strong>in</strong>formation related to<br />

plasma cells and MM. It must be noted that uncontrolled plasma cell growth is not<br />

always correspond to MM. Besides, there are two plasma cell related diseases like MM.<br />

One of them is monoclonal gammopathy of undeterm<strong>in</strong>ed significance (MGUS).<br />

In this diseases, similar to MM, abnormal plasma cells produce excess amounts of<br />

antibody prote<strong>in</strong>. However, these cells do not form an actual tumor or mass and do not<br />

cause any of the other problems seen <strong>in</strong> MM. The most dist<strong>in</strong>ction between MGUS and<br />

MM is that MGUS does not give rise to weak bones and anemia.<br />

Scientists who have studied the genes of the plasma cells <strong>in</strong> patients with MGUS<br />

found that the genetic background of these cells resembles <strong>myeloma</strong> plasma cells more<br />

than it resembles normal plasma cells. This f<strong>in</strong>d<strong>in</strong>g suggests that these cells are<br />

pr<strong>in</strong>cipally malignant, and people with MGUS can go on to develop MM (Weiss and<br />

Kuehl, 2010).<br />

Another type of abnormal plasma cell growth disease is solitary or isolated<br />

plasmacytoma. It differs from MM with regards to number of tumor. Patients with this<br />

disease have only one tumor rather than <strong>multiple</strong> tumors <strong>in</strong> different locations as <strong>in</strong><br />

<strong>multiple</strong> <strong>myeloma</strong>. Most often, a solitary plasmacytoma develops <strong>in</strong> a bone, but it is<br />

also rarely found <strong>in</strong> other tissues. When it beg<strong>in</strong>s <strong>in</strong> other tissues (such as the lungs), it<br />

is called an extramedullary plasmacytoma. As many people with a solitary<br />

plasmacytoma will develop <strong>multiple</strong> <strong>myeloma</strong> (Di Micco and Di Micco, 2005).<br />

1.2.4. Signs and Symptoms of MM<br />

The bone marrow microenvironment has a key role <strong>in</strong> both bone destructive and<br />

tumor growth process <strong>in</strong> MM (Roodman, 2009). There are two major k<strong>in</strong>ds of bone<br />

cells that basically work together to keep bones healthy and strong. One of them is<br />

osteoblasts that are responsible for lay<strong>in</strong>g down new bones and the other one is<br />

osteoclasts which break down worn or dy<strong>in</strong>g bones. These cells take part <strong>in</strong> the bone<br />

tissue. The ma<strong>in</strong> function of osteoblasts are both bone matrix synthesis and regulation<br />

11

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