Multiple Myeloma Flashcards
What is a myeloma protein?
An abnormal monoclonal antibody
What is multiple myeloma?
A condition in which a clone or multiple clones of malignant plasma cells over-produce and secrete into the bloodstream an abnormal monoclonal antibody
What is the second most common haematological malignancy?
Multiple myeloma
Antibodies are composed of heavy and light chains. What are the five types of heavy chains?
M A D G E
Antibodies are composed of heavy and light chains. What are the two type of light chains?
Lambda
Kappa
What are the two steps in the pathophysiology of multiple myeloma?
1) Development of monoclonal gammopathy of undetermined significance (MGUS)
2) Progression of MGUS to multiple myeloma
Almost all cases of multiple myeloma arise from what precursor?
Monoclonal gammopathy of undetermined significance (MGUS)
Most cases of monoclonal gammopathy of undetermined significance (MGUS) progress to multiple myeloma. T/F?
False
What is the term for the intermediate state between MGUS and multiple myeloma?
Smouldering or asymptomatic multiple myeloma
What constitutional features of malignancy may be present in cases of multiple myeloma?
Fever Weight loss Fatigue Loss of appetitie Generalised weakness
Describe the ‘CRAB’ acronym for the key presenting features of multiple myeloma?
C - calcium levels high
R - renal impairment
A - anemia
B - bone disease
Describe the occurrence of bone disease in patients with multiple myeloma
This can be widespread due to clonal proliferation within the bone marrow
Bone disease is seen as lytic lesions on imaging
Can cause pathological fractures
Describe the occurrence of renal impairment in patients with multiple myeloma
> 50% have raised creatinine at diagnosis
Kidneys can be affected due to light chain nephropathy where the kidney tubules are blocked by light chain casts
Kidneys can also be affected by proximal tubule necrosis due to the toxic effects of Bence Jones proteins in the urine
Describe the occurrence of anaemia in patients with multiple myeloma
This is caused by destruction of the normal bone marrow due to the proliferation of malignant plasma cells
Renal disease may also contribute due to EPO deficiency
How does multiple myeloma cause hypercalcaemia?
It induces bone demineralisation
Why is recurrent or persistent bacterial infection common in multiple myeloma?
Normal bone marrow is destroyed by the malignant plasma cell infiltrate which leads to immune dysfunction
When there are high paraprotein levels in multiple myeloma, hyper viscosity syndrome can occur. What are the typical symptoms of this?
Blurred vision
Headaches
Mucosal bleeding
Dyspnoea (due to heart failure)
What is the function of electrophoresis and immunofixation in screening for multiple myeloma?
Electrophoresis determines either there is an increased number of antibodies
Immunofixation determines which type of antibody has increased
Which type of antibodies are usually overproduced and secreted in multiple myeloma?
IgG
IgA
(or the accompanying light. chain)
Rather than multiple myeloma, the presence of IgM monoclonal antibody suggest which condition?
Waldenstrom macroglobulinaemia
Describe the use of the serum free light chain (SFLC) test in the screening of multiple myeloma?
SFLC looks at the amount of light chain in the blood which exists unbound to heavy chains. An elevated ratio between the kappa and lambda light chains is suggestive of multiple myeloma
What is the name of monoclonal light chain which are often detected in the urine in multiple myeloma?
Bence Jones protein
What test can be used to detect Bence Jones protein in multiple myeloma?
Urine electrophoresis
What are the three aspects of diagnostic testing for multiple myeloma?
Identifying a monoclonal antibody
Identifying bone marrow infiltration
Assessing for myeloma related end-organ damage
