Multiple myeloma Flashcards
What is Multiple Myeloma?
bone cancer that affects plasma cells-> these cells overgrow and crowd health cells in the bone marrow
What are the key symptoms of multiple myeloma?
Calcium overload >2.75mmol/L
Renal insufficiency
Anemia <10g/dl, Amyloid
Bone lesions
How can we diagnose Multiple Myeloma?
- Blood and urine
- Bone marrow biopsy (trephine or aspirate)
- Imaging (X-ray first line, MRI, PET-CT)-> MRI or PET-CT is the gold standard
What is measured in blood and urine to detect multiple myeloma?
Blood:
– FBC (thrombocytopenia, anemia, leukopenia), blood film (rouleax rbc)
– Renal function – urea, creatinine, potassium
– Serum protein electrophoresis (SPEP)
– Immunoglobulin levels (IgG and IgA)
– Serum free light chain analysis
– Calcium
– Serum b2 microglobulin-> determines severity and prognosis
Urine: Bence jones protein, 24-Hour Urine Protein Test, Urine Protein Electrophoresis (UPEP)
What are some differential diagnoses for MM?
- Metastases to bone marrow (from breast, lung, prostate) bc of anemia
- Lymphoma (WM) bc it produces IgM immunoglobulins and Monoclonal antibodies
- Osteoporosis bc of the bone pain
- Sepsis
What is a dangerous complication of MM?
Spinal cord compression
15-20% due to Prostate, breast, lung cancer
5-10% due to MM, Non-hodgkins lymphona, Renal cell carcinoma
What are the pain features of spinal cord compression?
- 60% from Thoracic Spine and 30% from
Lumbosacral Spine - Pain: 83-95% at diagnosis, well localized at diagnosis then it increases its severity, worse when lying flat, Radicular eith time esp when it’s lumbosacral
Appears as bilateral gripping girdle pain
What are the clinical features of spinal cord compression?
- Motor: 2/3 of ppl are not independent at the time of presentation
- Sensory
- Bowel and bladder disturbances: late sign, need catheterization
How is spinal cord compression treated?
- this is an MDT emergency -> neurosurgery, orthopedic
surgery, hematology, radiation oncology - For pain give either IV or Oral opiates
- IV dexamethasone (8-10mg every 8hrs)-> dose reduced after 48-72hrs until you stop it
- Radiotherapy: reduce pain and tumor growth
- Surgery
What type of surgery is indicated for spinal cord compression?
Indications:
- Spinal compression by bone fragments
– Unknown etiology and tissue required for diagnosis
– Tumour unresponsive to Radiotherapy
What type of surgery is used for spinal cord compression?
Simple Laminectomy
- Posterior compression of the spinal cord
Anterior decompression and mechanical stabilization
- Compression due to vertebral body
What is the diagnostic criteria for MM?
Bone marrow clonal plasma cells >10% of nucleated cells in
marrow
In addition to one or more ‘CRAB’ features or
Myeloma Defining Events (MDEs)
* Serum free light chain ratio ≥100
* >1 MRI bone lesion ≥5mm
* ≥ 60% bone marrow clonal plasma cells
What are the immunophenotypes of plasma cells?
Plasma cells are terminally differentiated B cells
* CD79a+
* CD138+
* Monoclonal for either Kappa or Lambda when malignant (proving monoclonality)
What is the cytogenetics of high risk MM?
– t(4;14)
– t(14;16)
– t(14;20)
– 1q gain
– del(17p)
– Nonhyperdiploid karyotype
How does kidney damage occur in MM?
- Tubular damage from excretion of light chains a.k.a.
Bence Jones protein - Amyloid deposition in glomeruli
- Light/Heavy chain deposition in glomeruli
- Effects of Hypercalcaemia with dehydration
- Hyperuricaemia
- Recurrent infections – pyelonephritis
Whats the treatment for MM?
- Poteasome inhibitors
- Immunomodulatory drugs
- Chemotherapy
- T-cell directed therapies
- Local radiotherapy
- Rehydration
- treatment for hypercalcemia, renal impairment, Infection
- prevent further bone damage
- +/- BM transplant
