Myeloma

Question 1

What is a myeloma?

Answer 1

A neoplastic disorder of plasma cells. They show normal plasma biomarkers but an abnormal phenotype. Clones either express kappa or lambda light chains

Question 2

Describe the presentation of myeloma

Answer 2

Non-specific symptoms such as:
- Back or rib pain (60%),
- Fatigue,
- Symptoms from hypercalcaemia (30%),
- Recurrent infections,
- Renal impairment due to small light chains which get stuck in glomerular BM.
These non-specific symptoms means a delay in diagnosis

Question 3

What is the classsic triad of myeloma?

Answer 3

1. Increased plasma cells in th ebone marrow,
2. Clonal immunoglobulin/paraprotein
3. Lytic bone lesions

Question 4

How is myeloma diagnosed?

Answer 4

1. Blood tests (FBC, ESR, U&Es, Ca, serum protein electrophoresis to detect high paraproteins and serum free light chain quantity).
2. Urine tests (look for light chains in urine (Bence-jones protein)
3. Bone marrow aspirate (RBC rouleaux and lots of plasma cells)
4. Imaging

Question 5

What type of imaging is used in myeloma?

Answer 5

MRI/CT as these are far better at detecting lytic lesions which occur due to the activation of osteoclasts

Question 6

What is the diagnostic criteria for myeloma?

Answer 6

Neoplastic plasma cells in the bone marrow that account for a minimum of 10% of cells and one of the following evidence of end organ damage: CRAB.
C - hypercalcaemia,
R - Renal insufficiency,
A - Anaemia,
B - Bone lesions (must have at least 1)
or biomarkers of malignancy:
1. Clonal plasma cell percentage>60%.
2. Serum free light chain ration >100
3. 1 focal lesion on MRI

Question 7

What is paraprotein?

Answer 7

Where the clonal neoplastic plasma cells produce a monoclonal protein (immunoglobulin). Mainly IgG or IgA (just another name for the antibodies produced by the malignant plasma cells)

Question 8

What is the treatment for myeloma?

Answer 8

• Asymptomatic (watch and wait)
• Symptomatic patients are given supportive treatment and chemotherapy

Question 9

What is the supportive treatment given to myeloma patients

Answer 9

• Bisphosphonates (reduce pain, reduce pathological fractures, reduce hypercalcaemia and reduce need for radiotherapy)
• Blood transfusion/epo,
• Good fluid intake,
• Prophylactic antibiotics,
• Vaccinations,
• Radiotherapy,
• Surgery
• Interventional radiotherpay

Question 10

What is the difference between myeloma and monoclonal gammopathy of undetermined significance?

Answer 10

While both have an increased percentage of plasma cells in bone marrow and high serum paraprotein. MGUS will rarely have bence jones protein and immune paresis and don’t have lytic bone lesions and other non specific symptoms.

Question 11

What is the significance of MGUS?

Answer 11

It has the potential to develop into a myeloma