Multiple Myeloma Flashcards
What is multiple myeloma?
- A blood cancer which develops from the plasma cells in the bone marrow
What are plasma cells?
- Plasma cells are part of the immune system
- They make proteins called antibodies
- Antibodies attack and kill bacteria and viruses so they are able to protect us from infections
What are the 5 main types of antibody?
- IgA
- IgG
- IgM
- IgD
- IgE
Where do plasma cells come from?
- The bone marrow produces stem cells
- Lymphoid stem cells
- Forms a lymphoblast
- Which can be a B or T lymphocyte
- The B lymphocyte produces plasma cells
What are the risk factors for Myeloma?
- Age ( more common in older people)
- Black/ African Decent
- More common in men
- Overweight
- Family History
- Lowered Immunity (HIV, SLE)
- MGUS (Monoclonal gammopathy of undetermined significance)
What is MGUS?
- MGUS excess of a single type of antibody or antibody component without other features of myeloma or cancer
- MGUS doesn’t typically cause any symptoms or need any treatment
- Only a small number of people with MGUS develop myeloma
What are the symptoms of Myeloma?
- Bone Pain
- Broken Bones
- Tiredness (fatigue), SOB = anaemia
- Infections that are consistent
- Nausea and loss of appetite
- Spinal Cord Compression (anywhere in your back/ worse when you cough/ stopping you sleep)
- High Calcium levels (feeling thirsty, passing urine more frequently, confusion and drowsiness)
What is CRAB ?
C - Calcium levels high - due to increased osteoclastic bone resorption caused by cytokine release ( constipation, nausea, poor appetite, abdominal pain, lethargy and confusion)
R - Renal Impairment (light chain deposition in the tubules) - dehydration, polydipsia, Anuria, polyuria, oedema
A - Anaemia (bone marrow infiltration suppresses erythropoioesis )
B - Bone Disease (bone lesions/pain - lytic bone lesions due to infiltration and osteoclast overactivity) - lower back/ pathological fractures
B- Bleeding: thrombocytopenia due to bone marrow infiltrations - bruising
I - Infection: Reduced production of normal immunoglobulins
Hyper-viscosity - blurred vision, headaches, nosebleeds and weight loss
What is Hyperviscosity Syndrome?
- high paraprotein levels
- Blurred vision, headaches, mucosal bleeding and dyspnoea
What is Spinal Cord Compression?
- Compression of the Spinal Cord due to metastasis
When to suspect Myeloma ?
- Unexplained Bone Pain
- Fatigue
- Hypercalcaemia
- Weight loss
- Cord Compression
- Hyperviscosity
- Recurrent infections
What are the symptoms of hypercalcaemia?
- bone pain, abdo pain, constipation, confusion, polyuria
What are the symptoms of cord compression?
- back pain, leg weakness, bladder/bowel dysfunction
What is involved in the screening for myeloma?
- Protein Electrophoresis ( gives us the characterisitic band patterns)
- Immunofixation ( fixes the antibodies in place, important for the identification of proteins after separation by electrophoresis)
- Urine Electrophoresis and serum free light chains ( this looks at the light chains which are secreted)
- Serum immunoglobulins
What typical pattern is seen in protein electrophoresis and Immunofixation for Myeloma?
- IgG, IgA or accompanying light chain
What would you think if you saw IgM monoclonal antibody seen on electrophoresis?
- Suggests Waldenstrom Macroglobulinemia
What is Waldenstrom Macroglobulinemia?
- A type of Non-Hodgkin’s Lymphoma
- Has high bound IgM
What is the results of the Urine Electrophoresis and serum free light chains?
- Looks at the light chains which are unbound to heavy chains
- The most important part is the ratio between kappa and lambda
- An elevated ration is suggestive of myeloma and requires further work-up
- In the urine electrophoresis: light chains are filtered by the kidneys into the urine, these are known as Bence-Jones proteins
What does it mean if patients have non-secretory MM?
- This is when the patient doesn’t have detectable paraprotein levels
What is the Diagnostic Criteria for Multiple Myeloma?
- Monoclonal Protein Present
- Bone marrow plasma cells >10%
- Organ Damage
