Multiple Myeloma

Question 1

What is multiple myeloma?

Answer 1

Neoplastic monoclonal proliferation of a plasma cell.
The abnormal plasma cells produce a monoclonal protein (type or fragment of an Ig).
These abnormal plasma cells typically accumulate in the bone marrow interfering with production of normal blood cells.

Question 2

The abnormal plasma cells can cause the destruction of ____ _____ and inhibit the normal function of _____ ____

Answer 2

bone tissue
bone marrow

Question 3

What are Bence Jones proteins?

Question 4

The monoclonal proteins produced by abnormal plasma cells may damage the _____ and cause excessive excretion of Bence Jones proteins in the urine

Answer 4

kidneys

Question 5

True or false: multiple myeloma can cause hypocalcemia

Answer 5

False
May cause hypercalcemia as the destruction of bone tissue can release Ca into the blood

Question 6

In 55% of multiple myeloma cases, the Ig made in excess is…

Answer 6

IgG

Question 7

In 20% of multiple myeloma cases, the Ig made in excess is…

Answer 7

IgA

Question 8

What age and ethnicity is particularly at risk for multiple myeloma?

Answer 8

70 y/o, Afro-Carribean

Question 9

What is mnemonic can help describe the symptoms of multiple myeloma?

Answer 9

Old CRAB

Question 10

What does C in Old CRAB stand for?

Answer 10

Calcium = hypercalcemia

Due to increased osteoclast bone resorption

Question 11

What are the clinical signs of hypercalcemia?

Answer 11

Bones (weak bones)
Stones (kidney stones)
Moans (abdominal pain)
Psychedelic groans

Question 12

What does R in Old CRAB stand for?

Answer 12

Renal failure
Due to hypercalcaemia and calcium oxalate renal stones
and
deposition of monoclonal Ig free light chains (Bence Jones proteins) in the renal tubules which can form casts and obstruct the tubules, damaging kidneys (light chain cast nephropathy

Question 13

What does A in Old CRAB stand for?

Answer 13

Anaemia
Due to bone marrow failure

Question 14

What does B in Old CRAB stand for?

Answer 14

Bone lesions

Bone marrow failure is painful, be suspicious in new onset back pain in elderly.

Question 15

What would a FBC and blood film show for patient with multiple myeloma?

Answer 15

Normocytic normochromic and increased ESR (Erythrocyte sedimentation rate, measure of inflammation)

Rouleaux formation (abnormal aggregation of RBCs)

Question 16

What would be used to test for Bence Jones proteins in suspected multiple myeloma?

Answer 16

Urine dipstick

Question 17

In a patient with multiple myeloma and U&E indicating renal failure, what particularly should be investigated?

Answer 17

Kidney stones

Question 18

What would a bone profile of multiple myeloma show?

Answer 18

Hypocalcaemia and increased ALP

Question 19

What would be used to investigate the particular monoclonal Ig produced in multiple myeloma?

Answer 19

Serum electrophoresis
M spike showing hypergammaglobulinemia for that specific Ig

Question 20

What would be a sign involving an x-ray for multiple myeloma?

Answer 20

Skull x-ray showing pepper pot skull
Due to osteolytic lesions punching out holes

Question 21

What would a bone marrow biopsy show in multiple myeloma?

Answer 21

Up to 10% are plasma cells

Question 22

What is the name for the condition that is a precursor to myeloma?

Answer 22

MGUS
Monoclonal Gammopathy of Undetermined Significance

Question 23

What is MGUS?

Answer 23

Abnormal monoclonal protein present in blood, premalignant. Still normal numbers of plasma cells in bone marrow. No end-organ damage, often asymptomatic.

Question 24

What is treatment for multiple myeloma?

Answer 24

Chemotherapy
Bisphosphonates eg alendronate
Dialysis
Consider BM stem cell transplant