Multiple myeloma

Question 1

What is myeloma?

Answer 1

cancer of plasma cells in bone marrow

Question 2

What are plasma cells?

Answer 2

B lymphocytes that have differentiated to produce antibodies

Question 3

What is multiple myleoma?

Answer 3

where myeloma affects multiple bone marrow areas in the body

Question 4

What does MGUS stand for?

Answer 4

monoclonal gammopathy of undetermined significance

Question 5

What is MGUS?

Answer 5

the production of a specific M protein without other features of myeloma or cancer originating from a single cell (often an incidental finding with no symptoms)

Question 6

What is smouldering myeloma?

Answer 6

involves abnormal plasma cells and paraproteins with no organ damage or symptoms

Question 7

Which has a higher risk of progressing to myeloma, MGUS or smouldering myeloma?

Answer 7

smouldering myeloma

Question 8

What are the 5 types of antibody?

Answer 8

1) A
2) G
3) M
4) D
5) E

Question 9

What is the M protein?

Answer 9

the antibody or part of an antibody produced by rapidly dividing plasma cells

Question 10

Give the CRAB presentations seen in myeloma:

Answer 10

1) calcium (raised)
2) renal failure
3) anaemia
4) bone lesions and pain

Question 11

What is the most common complication seen in myeloma?

Answer 11

anaemia

Question 12

Describe how myeloma can cause anaemia:

Answer 12

cancerous plasma cells invade bone marrow and suppress production of red blood cells, white blood cells and platelets

Question 13

What type of RBC anaemia is seen in myeloma?

Answer 13

normocyte (+ normochromic)

Question 14

What FBC findings are in line with myeloma?

Answer 14

1) anaemia (normocytic and normochromic)
2) leukopenia
3) thrombocytopenia

Question 15

Describe how myeloma causes bone disease:

Answer 15

the abnormal plasma cell releases cytokines which increase osteoclast and increase osteoblast activity resulting in more bone being reabsorbed than constructed

Question 16

Give 3 common sites of myeloma bone disease:

Answer 16

1) skull
2) long bones
3) ribs

Question 17

What is a key complication of myeloma bone disease?

Answer 17

the patchy osteolytic regions can lead to pathological fractures

Question 18

What is the name of the cancerous plasma cell tumours that can invade normal bone?

Answer 18

plasmacytomas

Question 19

What causes hypercalcaemia in myeloma?

Answer 19

increased osteoclast activity causes calcium reabsorption from the bone into the blood

Question 20

Describe how myeloma causes renal disease:

Answer 20

deposition of M proteins causes glomerulonephritis while hypercalcaemia adds further damage

Question 21

What term is used to refer to free light chains in urine?

Answer 21

Bence Jones protein

Question 22

Describe how myeloma causes hyperviscosity syndrome:

Answer 22

plasma protein increases when more proteins are in the blood such as M proteins

Question 23

Give 4 complications of hyperviscosity syndrome:

Answer 23

1) bleeding (particularly from nose and gums)
2) visual symptoms and eye changes (retinal haemorrhages)
3) neurological symptoms e.g. stroke
4) heart failure

Question 24

Give 5 risk factors for myeloma:

Answer 24

1) increasing age
2) male sex
3) black ethnic origin
4) obesity
5) family history

Question 25

Give 8 clinical presentations associated with myeloma:

Answer 25

1) persistent bone pain 2) pathological fractures 3) unexplained fatigue 4) unexplained weight loss 5) fever of unknown origin 6) hypercalcaemia 7) anaemia 8) renal impairment

Question 26

What blood test is used to detect M proteins?

Answer 26

serum protein electrophoresis

Question 27

What test is used to detect Bence-Jones protein?

Answer 27

urine protein electrophoresis

Question 28

What is the gold standard investigation for myeloma?

Answer 28

bone marrow biopsy

Question 29

What is the favoured imaging technique for assessing bone lesions in myeloma?

Answer 29

whole body MRI

Question 30

Give 4 X-ray findings associated with myeloma:

Answer 30

1) well defined lytic regions (punched out appearance) 2) diffuse osteopenia 3) abnormal fractures 4) pepper pot skull/ raindrop skull (multiple lytic lesions in the skull)

Question 31

Summarise the management strategy for myeloma:

Answer 31

1) chemotherapy 2) +/- stem cell transplant (depending on pt. fitness) 3) bone disease management

Question 32

Give 3 examples of chemotherapy drugs used in myeloma treatment:

Answer 32

1) bortezomib 2) thalidomide 3) dexamethasone

Question 33

Give 4 bone disease management methods used in myeloma treatment:

Answer 33

1) bisphosphates for suppressing osteoclast activity 2) radiotherapy for bone lesions 3) surgery to stabilise bones (e.g. intramedullary rod) 4) cement augmentation

Question 34

What is cement augmentation?

Answer 34

injecting cement into vertebral fractures or lesions to improve stability

Question 35

A fracture of which bone is indicative of myeloma if other risk factors are present?

Answer 35

vertebral

Question 36

Give 10 complications of myeloma:

Answer 36

1) VTE 2) infection 3) spinal cord compression 4) bone pain 5) peripheral neuropathy 6) renal failure 7) hyperviscosity syndrome 8) fractures 9) anaemia 10) hypercalcaemia