Multiple Myeloma

Question 1

What is multiple myeloma?

Answer 1

Abnormal growth of plasma cells, resulting in excessive production of a single type of immunoglobulin

Question 2

What is a paraprotein?

Answer 2

Monoclonal immunoglobulin present in blood or urine

Question 3

What is Monoclonal Gammopathy of Uncertain Significance (MGUS)?

Answer 3

Condition in which paraproteins are present yet no disease is present

Question 4

What immunoglobulins is multiple myeloma associated with?

Answer 4

IgG and IgA as these are produced by mature plasma cells

Question 5

What age group does multiple myeloma occur?

Answer 5

Peak incidence in 60s

Question 6

What is the prognosis of multiple myeloma?

Answer 6

Poor, median survival is 3 years

Question 7

Give risk factors for multiple myeloma

Answer 7

Radiation

Herbicides

HIV

Question 8

Multiple myeloma presentation can be associated with plasma cell proliferation or the para protein itself. What symptoms are related to plasma cells?

Answer 8

Bone disease

• Lytic bone lesions
• Pathological fractures, particularly the hip
• Cord compression
• Hypercalcaemia

Bone marrow failure

• Anaemia

Infections

Renal failure

Question 9

Multiple myeloma presentation can be associated with plasma cell proliferation or the para protein itself. What symptoms are related to paraproteins?

Answer 9

Renal failure: Immunoglobulin deposition and blockage of renal tubules

Hyperviscosity: Syndrome caused by increased viscosity in blood, impaired microcirculation and hypoperfusion

Hypogammaglobulinaemia: Impaired production of normal immunoglobulin

Amyloidosis: Group of diseases characterised by deposition of fibrillar protein

Question 10

Give complications of multiple myeloma

Answer 10

Amyloidosis

Renal failure

Spinal cord compression

Bone fractures

Question 11

What investigations are used in multiple myeloma diagnosis?

Answer 11

FBC

• Anaemia
• Thrombocytonpenia
• Decreased WCC

Bone marrow biopsy/aspirate under microscopy

Serum protein electrophoresis

Total immunoglobulin levels

Immunofixation

Light chain assay

Imaging/X-Ray

>ESR

• Raised ECR and osteoporosis represents multiple myeloma until proven otherwise

>Ca

Question 12

What bone marrow biopsy sign is diagnostic of multiple myeloma?

Answer 12

Excess plasma cells in the bone marrow

Must comprise >10% of total bone marrow cell population

Question 13

What blood film sign is seen in myeloma?

Answer 13

Rouleaux formation

Question 14

What is serum protein electrophoresis?

Answer 14

Identifies paraproteins

Separates proteins/antibodies by size and charge

Shows monoclonal band

Question 15

What is immunofixation?

Answer 15

Identifies what class of paraprotein is present

Question 16

What is light chain assay?

Answer 16

Identifies light chains

Question 17

What are light chains also known as?

Answer 17

Bence-jones proteins

Question 18

Where are Bence-Jones proteins found?

Answer 18

urine

Question 19

What investigations are used to assess complications of multiple myeloma?

Answer 19

FBC

>Ca

U&Es

>Urea and creatinine

Question 20

What is used in staging of multiple myeloma?

Answer 20

Albumin and B2 Microglobulins

Question 21

What x-ray sign is seen in multiple myeloma?

Answer 21

Salt and pepper skull

Question 22

How is multiple myeloma managed?

Answer 22

Chemotherapy, such as melphalan

Bisphosphonates

Radiotherapy

Steroids/prednisilone

Surgery

Autologous stem cell transplant, replace marrow after chemotherapy

Question 23

What surgical interventions are done in multiple myeloma?

Answer 23

Pinning of lone bones

Decompression of spinal cord

Question 24

Give an example of a biphosphonate

Answer 24

Zoledronic acid