Multiple Myeloma

Question 1

Define Multiple Myeloma

Answer 1

Haematological malignancy characterised by plasma cell proliferation -> bone lesions and monoclonal immunoglobulin production (paraprotein, IgG or IgA)

Also known as chief plasma cell dysplasia

Question 2

Aetiology of multiple myeloma

Answer 2

Unknown
May be a viral trigger
Chromosomal aberrations are frequent, esp. cytokines (IL-6)

Question 3

Risk factors of Multiple Myeloma

Answer 3

Ionising radiation
Agricultural work
Occupational chemical exposure e.g. benzene
Family history
Monoclonal gammopathy of undetermined significance (MGUS)

Question 4

Epidemiology of Multiple Myeloma

Answer 4

Males > females
Afro-Caribbeans > Caucasians > Asians
Median diagnosis age is 72

Question 5

Presenting symptoms of Multiple Myeloma

Answer 5

Most commonly, bone or back pain that does not improve

Calcinosis: Polyuria, polydipsia, mental changes, constipation, nausea

Renal impairment: Flank pain

Anaemia: fatigue, SOB,

Bone: sudden and severe pain, often in BACK and ribs. Osteoporosis -> fractures

Hyperviscosity: Neuro (headache), visual disturbances, bleeding

Infection and cord compression likely too - emergency

Question 6

Signs of multiple myeloma

Answer 6

Pallor
Tachycardia
Dehydration: loss of skin turgor and dry mucous membranes
Purpura
Hepatosplenomegaly 
Macroglossia
Carpal tunnel
Retinal haemorrhages (hyperviscosity)

Question 7

Investigations for Multiple Myeloma

Answer 7

Serum electrophoresis: Serum paraprotein (2/3 IgG, 1/3 IgA) | Monoclonal protein band (single dense band)
Blood film: Rouleaux formation with blue background
Urine: Bence Jones proteins
Radiographs: osteolytic lesions without sclerosis (PUNCHED OUT)
Free light chain assay: raised
Bone marrow aspirate and trephine: raised plasma cells

FBC: Normocytic anaemia
ESR/CRP: raised
Renal: Cr raised
U+Es: Calcium raised

Question 8

What is the criteria for diagnosis of multiple myeloma

Answer 8

1. Mononuclear protein band in serum or urine electrophoresis
2. Raised plasma cells on marrow biopsy
3. Evidence of end-organ damage from myeloma: Hypercalcaemia, renal insufficiency, anaemia
4. Bone lesions seen on skeletal survey

Question 9

What is the most common cause of death from multiple myeloma

Answer 9

Recurrent infections in the lung or urinary tract

Question 10

What does an asymptomatic patient who has a monoclonal band on electrophoresis suggest

Answer 10

Monoclonal gammopathy of undertermined significance

No end-organ damage
Distinguished from multiple myeloma by bone marrow biopsy

Monitor continuously for transformation into MM or Waldenstrom macroglobulinaemia