Multiple myeloma Flashcards
disease of what
malignant disease of plasma cells (fully differentiated B cells)
age of diagnosis
~70 y o (rare below age 40)
overproduction of what by the malignant plasma cells
paraprotein (aka immunoglobulin)
Plasma cells produce heavy chains and light chains separately and these chains are later assembled to form an intact immunoglobulin.
malignant melanoma causes what
- bone destruction and bone marrow failure (infiltration)
- inbalanced bone remodelling -> osteolytic bone lesions and hypercalc
- renal disease!! (remember the case from renal week)
- immunodeficiency
what is the asymptomatic pre-malignant stage that precedes myeloma
MGUS (monoclonal gammopathy of undetermined significance)
how is overproduction of paraprotein detected
serum
urine
specifically what is detected in the urine
free light chains (Bence Jones protein)
clinical features multiple myeloma (4)
- BONE: fractures of long bones, vertebral collapse, hypercalcaemia
- spinal cord compression (from mass of malignant plasma cells or from vetebral collapse)
- BONE MARROW SUPPRESSION: anaemia, neutropenia, thrombocytopaenia
- AKI due to deposition of light chains in renal tubules and hypercalc
initial ix
- FBC
- ESR
- U+Es (AKI)
- calcium
- albumin
- uric acid
- serum protein electrophoresis
- urine protein electrophoresis
- xray symptomatic areas
diagnostic ix
bone marrow aspirate and trephine (bone marrow) biopsy with plasma cell phenotyping
- immunofixation of serum and urine to confirm and show subtype
- whole body MRI: skeletal survey
diagnostic criteria
- plasma cells in marrow >=10%
- paraprotein in serum/urine
- evidence of myeloma related organ or tissue impairment (hypercal, renal problems, anaemia, lytic bone lesions, osteoporosis, pathological fractures)
course of disease
chronic relapsing remitting (after rx)
rx myeloma
chemo
autologous stem cell transplant
