Myeloma

Question 1

What is myeloma?

Answer 1

Cancer of the plasma cells (B-cells), monoclonal proliferation of abnormal Ig. Multiple myeloma affects multiple areas of the body.

Question 2

What is monoclonal gammopathy of undetermined significance?

Answer 2

Excess of a single type of Ab without other features of myeloma.

Question 3

What can monoclonal gammopathy of undetermined significance progress to?

Answer 3

Smouldering myeloma, premalignant.

Question 4

What happens when myeloma invades bone marrow?

Answer 4

Suppression of development of blood cells - anaemia, neutropenia, thrombocytopenia.

Question 5

What are the four key features of myeloma?

Answer 5

CRAB
C - calcium elevated
R - renal failure
A - anaemia
B - bone lesions/pain

Question 6

How do you investigate suspected myeloma?

Answer 6

1. FBC - low WCC
2. Calcium - raised
3. ESR - raised
4. Plasma viscosity - raised
5. Serum protein electrophoresis and urine Bence-Jones protein test
6. MRI/CT/x-ray for skeletal survey for bone lesions

Question 7

What is the management of myeloma?

Answer 7

1. Chemotherapy - bortezomib, thalidomide, dexamethasone
2. Stem cell transplant
3. VTE prophylaxis
4. Bisphosphonates and radiotherapy for bone disease