Multiple myeloma Flashcards
What is myeloma?
cancer of plasma cells in bone marrow
What are plasma cells?
B lymphocytes that have differentiated to produce antibodies
What is multiple myleoma?
where myeloma affects multiple bone marrow areas in the body
What does MGUS stand for?
monoclonal gammopathy of undetermined significance
What is MGUS?
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)
What is smouldering myeloma?
involves abnormal plasma cells and paraproteins with no organ damage or symptoms
Which has a higher risk of progressing to myeloma, MGUS or smouldering myeloma?
smouldering myeloma
What are the 5 types of antibody?
1) A
2) G
3) M
4) D
5) E
What is the M protein?
the antibody or part of an antibody produced by rapidly dividing plasma cells
Give the CRAB presentations seen in myeloma:
1) calcium (raised)
2) renal failure
3) anaemia
4) bone lesions and pain
What is the most common complication seen in myeloma?
anaemia
Describe how myeloma can cause anaemia:
cancerous plasma cells invade bone marrow and suppress production of red blood cells, white blood cells and platelets
What type of RBC anaemia is seen in myeloma?
normocyte (+ normochromic)
What FBC findings are in line with myeloma?
1) anaemia (normocytic and normochromic)
2) leukopenia
3) thrombocytopenia
Describe how myeloma causes bone disease:
the abnormal plasma cell releases cytokines which increase osteoclast and increase osteoblast activity resulting in more bone being reabsorbed than constructed
Give 3 common sites of myeloma bone disease:
1) skull
2) long bones
3) ribs
What is a key complication of myeloma bone disease?
the patchy osteolytic regions can lead to pathological fractures
What is the name of the cancerous plasma cell tumours that can invade normal bone?
plasmacytomas
What causes hypercalcaemia in myeloma?
increased osteoclast activity causes calcium reabsorption from the bone into the blood
Describe how myeloma causes renal disease:
deposition of M proteins causes glomerulonephritis while hypercalcaemia adds further damage
What term is used to refer to free light chains in urine?
Bence Jones protein
Describe how myeloma causes hyperviscosity syndrome:
plasma protein increases when more proteins are in the blood such as M proteins
Give 4 complications of hyperviscosity syndrome:
1) bleeding (particularly from nose and gums)
2) visual symptoms and eye changes (retinal haemorrhages)
3) neurological symptoms e.g. stroke
4) heart failure
Give 5 risk factors for myeloma:
1) increasing age
2) male sex
3) black ethnic origin
4) obesity
5) family history
Give 8 clinical presentations associated with myeloma:
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
What blood test is used to detect M proteins?
serum protein electrophoresis
What test is used to detect Bence-Jones protein?
urine protein electrophoresis
What is the gold standard investigation for myeloma?
bone marrow biopsy
What is the favoured imaging technique for assessing bone lesions in myeloma?
whole body MRI
Give 4 X-ray findings associated with myeloma:
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)
Summarise the management strategy for myeloma:
1) chemotherapy
2) +/- stem cell transplant (depending on pt. fitness)
3) bone disease management
Give 3 examples of chemotherapy drugs used in myeloma treatment:
1) bortezomib
2) thalidomide
3) dexamethasone
Give 4 bone disease management methods used in myeloma treatment:
1) bisphosphates for suppressing osteoclast activity
2) radiotherapy for bone lesions
3) surgery to stabilise bones (e.g. intramedullary rod)
4) cement augmentation
What is cement augmentation?
injecting cement into vertebral fractures or lesions to improve stability
A fracture of which bone is indicative of myeloma if other risk factors are present?
vertebral
Give 10 complications of myeloma:
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
