Multiple Myeloma Flashcards
What is myeloma?
A malignancy of plasma cells causing an overproduction of monoclonal immunoglobins.
What characterizes multiple myeloma?
Myeloma affecting multiple bone marrow areas in the body.
What is monoclonal gammopathy of undetermined significance (MGUS)?
Involves production of a specific paraprotein without other features of myeloma or cancer.
What is smouldering myeloma?
Involves abnormal plasma cells and paraproteins but no organ damage or symptoms.
What are the three key steps in the pathophysiology of myeloma?
- Genetic mutation in a cancerous plasma cell leads to uncontrolled multiplication. 2. Plasma cells accumulate in bone marrow. 3. Abnormal plasma cells produce specific paraproteins.
What are the effects of abnormal plasma cells in myeloma?
They lead to anaemia, leukopenia, thrombocytopenia, and kidney damage.
What is paraprotein (M protein)?
An abnormal antibody or part of an antibody produced by malignant plasma cells.
What is Bence Jones protein?
A term for light chain paraproteins when found in urine.
What are the four key clinical features of myeloma represented by CRAB?
- C - calcium elevated * R - renal failure * A - anaemia * B - bone lesions and bone pain
What is the most common symptom of myeloma?
Bone pain.
What causes renal failure symptoms in myeloma?
Uraemia, hyperphosphatemia, and fluid overload.
What are the presenting symptoms of myeloma?
- Persistent bone pain * Pathological fractures * Unexplained fatigue * Unexplained weight loss * Fever of unknown origin * Hypercalcaemia * Anaemia * Renal impairment
What are the risk factors for developing myeloma?
- Older age * Men * Black ethnic origin * Family history * Obesity
What lab tests are used in the investigation of myeloma?
- FBC * Calcium * ESR * Plasma viscosity * U&E * Serum protein electrophoresis * Serum-free light-chain assay * Urine protein electrophoresis
What is the diagnostic procedure for myeloma?
Bone marrow biopsy.
What imaging techniques are used to identify bone lesions in myeloma?
- Whole-body MRI * Skeletal survey (x-ray of entire skeleton)
What are typical findings in skeletal surveys for myeloma?
- Well-defined lytic lesions * Diffuse osteopenia * Abnormal fractures * Raindrop skull
What is the first line of management for myeloma?
High-dose chemotherapy.
What are common chemotherapeutic agents used in myeloma treatment?
- Bortezomib * Thalidomide * Dexamethasone
What types of stem cell transplants can be performed for myeloma?
- Autologous (using own stem cells) * Allogenic (from healthy donor)
What are the management options for bone disease in myeloma?
- Bisphosphonates * Radiotherapy * Surgery, cement augmentation
Classic blood smear finding in myeloma?
Rouleux formation
