Myeloma

Question 1

What is a Multiple Myeloma?

What do the Myeloma cells do?

What are the risk factors?

What is its progression characterised by?

What are the symptoms?

How is it diagnosed?

Answer 1

• PLASMA CELL malignancy in the Bone marrow
• Accumulate and produce M-proteins
• African, Family Hx, MGUS (precursor to myeloma), Age, Gender, Environment
• Remission and Relapse
• Pain (commonly in back), Anaemia, Hypercalcaemia, Fatigue, Dizziness
• • Bone marrow biopsy - aspirate and trephine
  • Serum Electrophoresis
  • CRAB Criteria - Calcium (↑), Renal impairment, Anaemia, Bone disease
  • SLiM features - Sixty % Plasma cells, Light chain ratio >100, Mri lesions

Question 2

Myeloma Bone Disease:
How do Myeloma cells affect Bone resorption?

Myeloma Renal Disease:
How does the Hypercalcaemia affect the Kidneys?

Amyloidosis:
What type of Amyloidosis is seen with Myeloma? What does this lead to?
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Infection:
What do Myeloma patients commonly present with?

Answer 2

• Upregulate RANK-L and downregulate OPG = ↑Activated Osteoclasts
• Expand and put pressure on bone = Pressure atrophy of bone, which creates localised Osteolytic lesions
• Renal stones form, which can :
  o Obstruct urine flow leading to urinary retention with increased risk of UTI
  o Hydronephrosis causing pressure atrophy of the kidney
• Overactive RAAS, causing HTN
• AL amyloid, leading to Proteinuria and Renal failure
• Lobar Pneumonia and Shingles