Intro To Haematology Lecture Block Myeloma 18.01.24

Question 1

What is the name of the cancer of differentiated B-lymphocytes?

Answer 1

Multiple myeloma

Question 2

Features of multiple myeloma

Answer 2

• Accumulation of malignant plasma cells in the bone marrow leading to progressive bone marrow failure
• Production of a characteristic paraprotein
• Kidney failure
• Destructive bone disease and hypercalcaemia

Question 3

What is CRAB the mnemonic for myeloma

Answer 3

C - ad Ca>0.25mmol/l above upper limit of normal or >2.75mmol/l

R – renal impairment, creatinine>173mmol/l (40% pts at Δ have some degree of RF; 10% req dialysis Dimopolous et al, 2008, Leukaemia, 22, 1485-1493 Pathogenesis and treatment of renal failiure in multiple myeloma)

A – anaemia

B – lytic lesions, osteoporosis c compression #, spinal cord compression
nb also hyperviscosity; recurrent infection ie >2 episodes in 12/12 , amyloid; raised ESR and globulin frequent signals

Question 4

What is the go to test for myeloma?

Answer 4

Serum electrophoresis (SEP) - separation by molecular electric charge, if a discrete additional band seen or bands fuzzy or suppressed, proceed to immunofixation

Question 5

Summary of myeloma tests?

Answer 5

1. Electrophoresis - if discrete band, fuzzy or suppressed —> proceed to next
2. Immunofixation - repeat electrophoresis plus identifies mono clones via the addition of specific antibodies
3. Densitometry scan

Question 6

What is the precursor to myeloma?

Answer 6

Monoclonal gammopathy of undetermined significance (MGUS)

Smouldering myeloma

Symptomatic myeloma