multiple myeloma

Question 1

define myeloma

Answer 1

a malignant tumour of the bone marrow

Question 2

define plasma cell dyscrasias

Answer 2

an abnormal state of a body part

Question 3

precursor of myeloma

Answer 3

MGUS
monoclonal gammopathy of undetermined significance

Question 4

examples of plasma cell dyscrasias

Answer 4

• myeloma
• solitary plasmacytomas
• multiple solitary plasmacytoma
• extramedullary plasmacytoma

Question 5

what is multiple myeloma

Answer 5

neoplastic proliferation of bone marrow plasma cells

Question 6

what is multiple myeloma characterises by (3)

Answer 6

• Monoclonal protein in serum/urine
• Lytic bone lesions/ CRAB end organ damage
• Excess plasma cells in bone marrow

Question 7

is multiple myeloma easy to diagnose

Answer 7

no it is difficult to diagnose because it has non specific symptoms

Question 8

criteria for diagnosis of myeloma

Answer 8

• Protein in blood
• Bone marrow plasma cells in excess of 10%
• CRAB (cancer renal anaemia bone)

Question 9

chromosomal abnormalities with myeloma

Answer 9

T(11;14) most common

13q- associated with treatment resistance and poorer prognosis

Question 10

common presenting features of myeloma

Answer 10

• Tiredness and malaise
• Bone/back pain +/- fractures
• Infections
• Non-specific
• Laboratory

Question 11

laboratory findings of myeloma

Answer 11

• anaemia
• abnormal FBC
• renal failure
• hypercalcaemia
• raised globulins
• raised ESR
• serum/urine paraprotein

Question 12

what is the main cause of death in myeloma

Answer 12

infection

but often curable if managed early

Question 13

what is amyloidosis

Answer 13

a group of rare, serious conditions caused by a build-up of an abnormal protein called amyloid in organs and tissues throughout the body

Question 14

how does myeloma develop into leukaemia

Answer 14

Clonal expansion -> MGUS -> early myeloma -> late myeloma -> plasma cell leukemia

Question 15

treatment for myeloma

Answer 15

radiotherapy

Question 16

response rates to myeloma treatment

Answer 16

Many respond to treatment, but all will eventually relapse

Can prolong survival by keeping the disease in plateau phase rather than try and cure it

Both disease and treatment have morbidity – sickness and mortality – death

Question 17

is myeloma a chronic disease

Answer 17

yes but a long period of good quality of life can be expected for most patients

Question 18

peak age of presentation of myeloma

Answer 18

60

Question 19

pathology of myeloma

Answer 19

1. clinal proliferation of plasma cells
2. malignant plasma cells produce an excess of IgG and IgA
3. protein deposition in urine

Question 20

symptoms of myeloma (CRAB)

Answer 20

C - calcium raised cancer symptoms, confusion
R - renal failure
A - anaemia
B - bone pain

Question 21

why does myeloma cause bone pain

Answer 21

increased osteoclastic activity causes bone destruction

1. osteolytic lesions
2. pathological fractures
3. spinal cord compression
4. hypercalcemia

Question 22

why doe myeloma cause anaemia and bleeding

Answer 22

due to BM infiltration

Question 23

diagnosis & investigations for myeloma

Answer 23

1. serum and urine electrophoresis - B2 microglobulin
2. blood film - aggregations of RBC’s
3. bence jones protein in urine
4. x ray - shows pepper pot skull and lyses in bones
5. BM aspiration shows excess plasma cells

Question 24

treatment of myeloma (4)

Answer 24

1. Chemo
2. BM transplant
3. Bisphosphonates e.g. zolendronate
4. Correction of anaemia with transfusions of RBCs and EPO