Multiple myeloma

Question 1

Define Multiple Myeloma

Answer 1

Fully mature B cell (plasma cell) cancer-
(earlier B cell precursor will lead to ALL, or CLL)

cancer of terminally differentiated B cells-

Question 2

Aetiology and risk factors of Multiple Myeloma

Answer 2

Usually transformation that accumulate from pre-malignant condition
Interaction with other parts of body cause weird Sx
Many IgG/A produced. But also can produce excess light chain (w/o any heavy)-Serum free light chains-more damaging than IgG/A-can pass in Kidney-as pH change-precipitate and destroy kidney

B cells also activate Osteoclasts-bone issues-esp around tumour

risk
age
obesity
FHx
pre-malignanant condition

Question 3

Epidiemology of Multiple Myeloma

Answer 3

Men> women
2nd most common blood cancer >4000 per year
old > young
Black > white

Question 4

Signs and Sx of Multiple Myeloma

Answer 4

CRAB
Calcium elevated
Renal impairment (often acute kidney failure)
Aneamia
Bone lesion (80%)-pepper pot skull

other-infection/pneumonia, paralysis (cord compression), fatigue, back pain, renal failure

NO SPLENOMEGALY

and need monoclonal protein on investigations

Question 5

Investigations of Multiple Myeloma

Answer 5

BM aspirate/core biopsy-diagnostic tool

XRAY-bone punched out lesion, pepper pot skull, osteopenia
MRI-see vertebrae better, osteopenia, oestolytic lesions

expect CRAB_
high calcium, anaemia, Renal issues

Increase in serum globulin (depending on which one is being produced)
can haves suppression of others Ig so total is okay

Electrophoreses—monoclonal Ig paraprotein
Find a lot of Serum free light chains in URINE (not that many in blood)

BUT BUT BUT-to exclude myeloma, must make sure NO Serum free light chain. even if nothing else are present

Question 6

Complications of Multiple Myeloma

Answer 6

Cord compression
if spine becomes to weak it crushes itself and slowly (or acutely) compresses the cord-v bad

hypercalcaemia-drowsy, fatigue, confusion, heart problems-need Mx

Question 7

management of Multiple Myeloma

Answer 7

Supportive-Dialysis, manage hypercalcemia, help aneamia
urgent-steroids, fluids, bisphosphonates

For Multiple Myeloma
-chemotherapy-alkalating agents (melphalan)
Steroids
Immunemodulation therapy–thalidomine (the one that removes arms on babies)-also good anti inflammatory for MM

usually remove stem cells, kill everything with Melphalan, then put stem cells back in

not really curative tho