Multiple myeloma Flashcards
What is multiple myeloma?
Plasma cell dyscrasia (abnormal or disorder state of body or bodily part) characterised by abnormal clonal proliferation of plasma cells.
Aetiology of multiple myeloma?
Cause is largely unknown
Median age at diagnosis - 65 years
Other risk factors include:
- Male sex
- Black African ethnicity
- Family history
- Obesity
What are plasma cells?
Plasma cells are B cells (B lymphocytes) of the immune system. Must be activated to produce a certain antibody.
Found in the bone marrow.
What is myeloma?
A cancer of a specific type of plasma cell where there is a genetic mutation causing it to rapidly and uncontrollably multiply.
What is the one antibody type that the plasma cells produce?
Immunoglobulins
What is the most common immunoglobulin type in myeloma?
More than 50% of the time, this is immunoglobulin type G (IgG)
What is a protein that can be present in the urine for myeloma patients?
“Bence jones protein” can be found in the urine of many patients with myeloma. It is a part (subunit) of the antibody called the light chains.
What is myeloma bone disease?
Dysregulation of the bone remodelling resulting in typical lytic lesions, usually seen in skull, long bones, spine and ribs.
There is increased osteoclastic activity without increased osteoblast formation of the bone leading to fractures of the long bones, vertebral collapse and hypercalcaemia.
What is myeloma renal disease?
With myeloma, 30% of patients have renal impairment at diagnosis, this is due to:
Free light chain secretion leads to deposition in renal tubules, causing renal impairment by cast nephropathy.
Other factors such as hypercalcaemia and dehydration, use of NSAID’s and deposition of AL amyloid.
Symptoms of myeloma?
Bone pain: most commonly backache, due to vertebral involvement (60%).
Weakness
Fatigue
Symptoms of amnesia
Weight loss
Recurrent infections
Rarely, symptoms/signs of hyper viscosity and bleeding due to thrombocytopenia (easy bruising/bleeding etc).
Signs of myeloma?
Anaemia
Renal failure
Lytic bone lesions
Hypercalcaemia
Initial investigations for myeloma?
If symptoms and signs from clinical examination and history suggest myeloma, the following initial investigations can be used:
Bloods: FBC, U+E’s and creatinine, calcium, CRP and plasma viscosity.
Serum protein electrophoresis: shows type of paraprotein.
Plain x-ray: for symptomatic areas.
Diagnostic tests for myeloma?
Bone marrow aspirate and trephine biopsy: with plasma cell phenotyping.
Immunofixation: of serum and urine to confirm and show the subtype of the paraprotein.
What is a skeletal survey as a diagnostic test for myeloma?
First line: MRI
Whole body CT can be used if MRI unsuitable.
Is myeloma curable?
No
Currently regarded as an incurable chronic disease - usually takes a relapsing-remitting course.
Treatment aims to improve quality of life and prolong survival.
