Multiple myeloma

Question 1

Define multiple myeloma

Answer 1

Multiple myeloma (MM) is a plasma cell dyscrasia characterised by terminally differentiated plasma cells, infiltration of the bone marrow by plasma cells, and the presence of a monoclonal immunoglobulin (or immunoglobulin fragment) in the serum and/or urine.

Question 2

Explain the aetiology / risk factors of multiple myeloma

Answer 2

> Monoclonal gammopathy of undetermined significance
> Abnormal free light chain ratio
> FHx
> Radiation exposure
> Petroleum products exposure

Question 3

Summarise the epidemiology of multiple myeloma

Answer 3

In Europe, the incidence of multiple myeloma (MM) is 4.5 to 6.0 per 100,000 per year, with a mortality of 4.1 per 100,000 per year.

Question 4

Recognise signs and symptoms of multiple myeloma

Answer 4

> Anaemia
> Bone pain
> Infections
> Fatigue
> Renal impairment

Question 5

Identify appropriate investigations for multiple myeloma and interpret the results

Answer 5

> serum/urine electrophoresis (paraprotein spike )
skeletal survey (osteopenia, osteolytic lesions, pathological fractures)
whole-body, low-dose computed tomography (WBLD-CT)- Osteolytic lesions, fractures
serum free light-chain assay- high
bone marrow aspirate and biopsy- monoclonal plasma cell infiltration
serum calcium- hypercalcaemia
FBC- anaemia
creatinine, urea- renal impairment
serum beta2-microglobulin <3.5 mg
serum albumin >35g/L