Multiple myeloma

Question 1

Define multiple myeloma? Which ethnicity is more affected? Cause?

Answer 1

a malignant plasma cell dyscrasia characterised by the proliferation of abnormal plasma cells in the bone marrow.

Afro-Caribbean descent are affected twice as frequently as Caucasians.

Genetic
Radiation or chemical exposure
Immunosuppressive conditions.

Question 2

Presentation of multiple myeloma?

Answer 2

CRAB HAI:

HyperCalcaemia - Results in: moans (painful bones), stones (renal stones), groans (GI symptoms) and psychiatric moans (neurological effects such aslethargy, fatigue, memory loss, psychosis, depression)

Renal impairment
Anaemia
Bone pathology
Hyperviscosity
Amyloidosis
Infection

Question 3

Diagnosis/IVx multiple myeloma?

Answer 3

Bone marrow aspirate and biopsy -GOLD STANDARD (f there are >10% plasma cells in the bone marrow)

Serum and/or urine electrophoresis (paraprotein spike (typically IgG))

Serum free light chain assay (Bence Jones protein)

Skeletal survey -Xray, CT/MRI -more sensitive than xray

Bloods
- FBC
- U&Es
- ESR
- calcium

Question 4

Management of multiple myeloma?

Answer 4

Acute emergency:
* Acute renal failure -swift treatment of volume depletion is critical
* Hypercalcaemia – fluid and bisphosphonates needed
* Hyperviscosity – requires plasmapheresis
* Spinal cord compression –radiotherapy emergency

Conservative management -minimal sx and no end-organ damage

Haematopoietic stem cell transplantation
- minimal comorbidities up to age 70.
- induction therapy included

Palliative care

Question 5

Complications of multiple myeloma?

Answer 5

Bone disease
Renal dysfunction
Infections
Anaemia