Multiple myeloma

Question 1

MM
abnormal clonal proliferation of {…} cells

Answer 1

plasma

Question 2

CRAB HAI

1. […] : this arises primarily due to increased osteoclast-mediated bone resorption.
2. […] impairment: this occurs due to multiple factors e.g. light chain ([…] […]) deposition in the kidneys and hypercalcaemia.
3. […] : note that due to marrow infiltration by the tumour other cytopenias can occur (e.g. thrombocytopenia and leukopenia).
4. Bone pathology: osteolytic lesions are common. This can lead to […]
5. […] : this can present with headache, visual disturbances, and thrombosis.
6. […] (AL): this has multiple sequelae including e.g. cardiac failure and neuropathies.
7. Infection: recurrent infection occurs secondary to […] and […] (there is low levels of functional IgG).

Answer 2

HyperCalcaemia
Renal, IgG kappa
Anaemia
fractures
Hyperviscosity
Amyloidosis
leukopenia, immunoparesis

Question 3

Workup
1. Bloods
2. Skeletal survey -osteolytic bone lesions and pathological fractures.

Diagnostic
1. Serum and/or urine electrophoresis: this will show a […] spike (typically Ig[…]).
2. If EP negative –> serum free light chain essay ( […] […]protein): […] levels
3. […] […] […]: >10% plasma cells

Answer 3

1. CRA
2. B - XRAY - osteolytic bone lesions and pathological fractures.

paraprotein
G
Bence Jones, raised
Bone marrow biopsy

Question 4

Investigations to inform prognosis

Answer 4

CRP and LDH
Beta-2 microglobulin
FISH and cytogenetic analysis

Question 5

Mx
[…] regimen (with Melphalan) followed by {…} stem cell transplant

Other option is […], with higher remission rate but also higher mortality rate

If unsuitable for transplant: MPT
Mephalan, […], […]

Answer 5

Conditioning
autologous

allogenic

Melphalan plus Prednisolone plus Thalidomide