multiple myeloma Flashcards
define mutliple myeloma
Malignant disease of plasma cells in bone marrow, characterised by proliferation and production of excessive paraproteins
what is myeloma
Myeloma is a type of cancer affecting
plasma cells in the bone marrow.
pathophysiology of multiple myeloma
- The plasma cells have a genetic
mutation - causes them to produce large quantities of a specific paraprotein, which is an abnormal antibody or part of an antibody (often the light chain).
which systems in the body are affected by the abnormal levels of plasma cells
- Bone destruction
- Neurological symptoms
- Bone marrow failure
- Renal impairment – due to light
chains in the renal tubule. - Recurrent infections
signs and symptoms of multuple myeloma
CRAB
*Calcium levels are high
* Renal impairment
* Anaemia
* Bone pain (commonly as
backaches
hyperviscosity sydnrome
why does multiple myeloma cause hyperviscosity syndrome
– due to
increased circulating Igs, presents a
triad of mucosal bleeding,
neurologic, and visual changes:
presentation of hyperviscosity syndrome
- Epistaxis, gum, or rectal bleeding
- Vertigo
- Paraesthesia’s
- Visual changes
- Hearing loss
- Headaches/seizures/somnolence
- Heart failure
- SOB/hypoxia
- Fatigue
how is multiple myeloma usually found
Presentation can be vague and is often “incidentally” found on routine blood tests.
3 main investigations for multiple myeloma
- Serum electrophoresis
- Immunofixation
- serum FLC
what does serum electrophoressis for multiple myeloma do
detect paraproteins (abnormal abs), which appear as monoclonal bands.
what does immunofixation for multiple myeloma do
determine the type of
paraprotein e.g. IgG, IgM etc
what does serum FLC for multiple myeloma do
(free light chain assay) –
detect abnormally abundant light chains.
supporting investigations for multiple myeloma
FBC, ESR, CRP, U&Es
other key investigations for multiple myeloms
- blood film
- urine electrophoresis
- bone marrow aspirate
- x rays
what does multiple myeloma blood film show
rouleax formation
what does urine electrophoresis for multuple myeloma show
Bence Jones
protein
what does bone marrow aspirate for multiple myeloma show
plasma cell
infiltration percentage
what does x ray for multiple myeloma show
lytic lesions e.g. raindrop/pepper-pot skull
dependent conditions for diagnosis of multiple myeloma
Diagnosis of multiple myeloma
requires at least 2 of:
* Paraproteinemia OR
Bence-Jones protein
* Radiologic evidence of lytic
lesions e.g. pepperpot skull
* Increase in bone marrow plasma
cells >30%
* >1g light chains excreted/day
* Serum monoclonal Ig OR urine
monoclonal light chains (on
electrophoresis)
is complete remission attained in multiple myeloma
Complete remission is never attained in
myeloma, so management is conservative:
* Infection
* Renal failure
* Haemorrhage
treatment for multiple myeloma
usually involves chemo which
may include:
* Bortezomib
* Thalidomide
* Dexamethasone
what is the most effectve treatment for multiple myeloma
if suitable, high-dose chemo followed by
stem cell transplant, either:
* Autologous (own stem cells)
* Allogeneic (donor’s stem cells)
very high risk though
what are Bisphosphonates used for in multiple myeloma
may be used to suppress osteoclast activity to alleviate bone pain.
what is Kyphoplasty
a surgical option
for pathological fractures
risks from myeloma treatment
The use of long-term NSAIDs to treat
myeloma (e.g. for bone
pain) can result in amyloidosis and cause renal impairment.
what is Monoclonal Gammopathy of
Undetermined Significance
(MGUS)
A related disorder that can precede
or develop into myeloma. It is defined
by the detection of low levels of
paraprotein, without symptoms
what is smouldering myeloma
a stage between MGUS and myeloma
ie a higher risk of developing into
myeloma than MGUS but still does
not cause damage.
