multiple myeloma Flashcards
define myeloma
a malignant tumour of the bone marrow
define plasma cell dyscrasias
an abnormal state of a body part
precursor of myeloma
MGUS
monoclonal gammopathy of undetermined significance
examples of plasma cell dyscrasias
- myeloma
- solitary plasmacytomas
- multiple solitary plasmacytoma
- extramedullary plasmacytoma
what is multiple myeloma
neoplastic proliferation of bone marrow plasma cells
what is multiple myeloma characterises by (3)
- Monoclonal protein in serum/urine
- Lytic bone lesions/ CRAB end organ damage
- Excess plasma cells in bone marrow
is multiple myeloma easy to diagnose
no it is difficult to diagnose because it has non specific symptoms
criteria for diagnosis of myeloma
- Protein in blood
- Bone marrow plasma cells in excess of 10%
- CRAB (cancer renal anaemia bone)
chromosomal abnormalities with myeloma
T(11;14) most common
13q- associated with treatment resistance and poorer prognosis
common presenting features of myeloma
- Tiredness and malaise
- Bone/back pain +/- fractures
- Infections
- Non-specific
- Laboratory
laboratory findings of myeloma
- anaemia
- abnormal FBC
- renal failure
- hypercalcaemia
- raised globulins
- raised ESR
- serum/urine paraprotein
what is the main cause of death in myeloma
infection
but often curable if managed early
what is amyloidosis
a group of rare, serious conditions caused by a build-up of an abnormal protein called amyloid in organs and tissues throughout the body
how does myeloma develop into leukaemia
Clonal expansion -> MGUS -> early myeloma -> late myeloma -> plasma cell leukemia
treatment for myeloma
radiotherapy
response rates to myeloma treatment
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
is myeloma a chronic disease
yes but a long period of good quality of life can be expected for most patients
peak age of presentation of myeloma
60
pathology of myeloma
- clinal proliferation of plasma cells
- malignant plasma cells produce an excess of IgG and IgA
- protein deposition in urine
symptoms of myeloma (CRAB)
C - calcium raised cancer symptoms, confusion
R - renal failure
A - anaemia
B - bone pain
why does myeloma cause bone pain
increased osteoclastic activity causes bone destruction
- osteolytic lesions
- pathological fractures
- spinal cord compression
- hypercalcemia
why doe myeloma cause anaemia and bleeding
due to BM infiltration
diagnosis & investigations for myeloma
- serum and urine electrophoresis - B2 microglobulin
- blood film - aggregations of RBC’s
- bence jones protein in urine
- x ray - shows pepper pot skull and lyses in bones
- BM aspiration shows excess plasma cells
treatment of myeloma (4)
- Chemo
- BM transplant
- Bisphosphonates e.g. zolendronate
- Correction of anaemia with transfusions of RBCs and EPO
