Multiple Myeloma

Question 1

what is multiple myeloma?

Answer 1

haematological malignancy characterised by plasma cell proliferation

Question 2

how does multiple myeloma arise?

Answer 2

due to genetic mutations which occur as b-lymphocytes differentiate into mature plasma cells

Question 3

what is the median age at presentation?

Answer 3

70 years old

Question 4

what mnemonic is used to remember multiple myeloma features?

Answer 4

CRABBI
Calcium
Renal
Anaemia
Bleeding
Bones
Infection

Question 5

what calcium abnormality is seen in multiple myeloma?

Answer 5

hypercalcaemia
* constipation
* nausea
* anorexia
* confusion

Question 6

why is calcium abnormal in multiple myeloma?

Answer 6

increased osteoclastic bone resorption caused by local cytokines released by myeloma cells

Question 7

what renal impairment is seen in multiple myeloma?

Answer 7

renal damage
* dehydration
* increasing thirst

Question 8

what is the cause of renal damage in multiple myeloma?

Answer 8

• monoclonal production of immunoglobulins results in light chain deposition within the renal tubules
• amyloidosis
• nephrocalcinosis
• nephrolithiasis

Question 9

what is the cause of anaemia in multiple myeloma?

Answer 9

bone marrow crowding suppresses erythropoiesis

Question 10

what is the cause of bleeding in multiple myeloma?

Answer 10

bone marrow crowding results in thrombocytopenia

Question 11

what bone features are seen in multiple myeloma?

Answer 11

• pain (especially in the back)
• increased risk of pathological fratures

Question 12

what is the cause of bone pathology in multiple myeloma?

Answer 12

bone marrow infiltration by plasma cells and cytokine-mediated osteoclast overactivity creates lytic bone lesions

Question 13

what is the cause of infection in multiple myeloma?

Answer 13

reduction in the production of normal immunoglobulins results in increased susceptibility to infection

Question 14

what are the features of multiple myeloma?

Answer 14

• hypercalcaemia
• renal damage
• anaemia
• bleeding/bruise
• bone pain/fractures
• infection
• amyloidosis - e.g. macroglossia
• carpal tunnel syndrome
• neuropathy
• hyperviscosity

Question 15

what findings represent multiple myeloma until proven otherwise?

Answer 15

raised ESR + osteoporosis

Question 16

what is seen on peripheral blood film in multiple myeloma?

Answer 16

rouleaux formation

Question 17

what blood tests are done in multiple myeloma?

Answer 17

• FBC –> anaemia
• peripheral blood film
• U&Es –> renal failure
• bone profile –> hypercalaemia

Question 18

what are the results of protein electrophoresis in multiple myeloma?

Answer 18

raised concentrations of monoclonal IgA/IgG proteins

Question 19

what are monoclonal IgA/IgG proteins in the urine known as?

Answer 19

bence jones proteins

Question 20

what are bence jones proteins indiciative of?

Answer 20

multiple myeloma

Question 21

what does the bone marrow aspiration show in multiple myeloma?

Answer 21

raised number of plasma cells

Question 22

what imaging is done in multiple myeloma?

Answer 22

• whole-body MRI
• skull x-ray

Question 23

descrip the skull x-ray findings in multiple myeloma?

Answer 23

‘rain-drop skull’
random pattern of dark spots

Question 24

what is the diagnostic criteria for multiple myeloma?

Answer 24

1 major + 1 minor
OR
3 minor + symptoms

Question 25

what are the major criteria for multiple myeloma?

Answer 25

• plasmacytoma
• 30% plasma cells in bone marrow
• elevated levels of M protein in blood or urine

Question 26

what are the minor criteria for multiple myeloma?

Answer 26

• 10-30% plasma cells in bone marrow
• minor elevation in the levels of M protein in blood or urine
• osteolytic lesions
• low levels of antibodies in the blood