Multiple Myeloma

Question 1

What is MM?

Answer 1

Increase in plasma cells, accumulates in BM –>

Question 2

When should a dx of MM be considered?

Answer 2

Increase Calcium
Renal Impairment
Anaemia normocytic or macrocytic
Bony lesions

Question 3

Investigations for MM

Answer 3

Serum Electrophoresis
>Identifieds monoclonal band

Immunofixation electrophoresis
>Is it iga, igg, or igM (IgM is rare)

Serum free light chains
>Small % of myelomas will only have fragments of paraprotein

> Urine BJones
Not essential unless above is negative

> Skeletal Survey
Order if at least one of the above tests is present

FBC, UEC, LFT’s, LDH,

Question 4

Differentiating MM with Monoclonal Gammopathy of unknown significance (MGUS) AND
Smouldering MM

Answer 4

1/ MGUS

• Serum monoclonal protein <30g/L
• Bone marrow clonal plasma cells <10%
• NIL end organ damage
• No evidence of other B cell lymphoproliferative disorders

2/Smouldering MM

• Serum monoclonal protein ≥30g/L
• Bone marrow monoclonal plasma cells ≥10%
• NIL end organ damage

3/MM

• Monoclonal protein in serum and/or urine
• Bone marrow clonal plasma cells or biopsy proven plasmacytoma
• Myeloma-related organ or tissue impairment