Multiple Myeloma

Question 1

Outcomes of MGUS

Answer 1

• 57% no progression
• > 50% M protein increase with no clinical progression - 9%
• MM, WM, AL - 11%

Question 2

Diagnostic criteria for multiple myeloma

Answer 2

Question 3

Presentation of multiple myeloma

Answer 3

• Bone pain with negative bone scan
• Low BMD with paraprotein
• Normo-macrocytic anaemia with high total protein
• Acute renal failure with anaemia
• Back pain with anaemia
  ** Hyperviscosity - confusion, headache, visual changes, mucosal haemorrhage, high output CCF.
  ** Worry if IgM > 50, IgA > 70, IgG > 100
  Plasmapharesis > 50% reduction

Question 4

High risk genetics multiple myeloma

Answer 4

17p
t(14;16)
t(16;20)
t(4;14) - less bad
1q+
del 1p