Myeloma Flashcards
Define plasma cell
B lymphocytes that produce antibodies
Cancer in a specific type of plasma cell results in the production of..
Specific paraprotein (or M protein)
What is Monoclonal gammopathy of undetermined significance (MGUS)?
Production of a specific paraprotein without other features of myeloma or cancer
Define smouldering myeloma
Abnormal plasma cells and paraproteins but no organ damage or symptoms
Define Bence Jones protein
Free light chains in the urine
Four key symptoms of myeloma
C – Calcium (elevated)
R – Renal failure
A – Anaemia
B – Bone lesions and bone pain
What is the most common complication of myeloma?
Anaemia - cancerous plasma cells invade the bone marrow resulting in suppression of the other blood cell lines
Describe the type of anaemia that occurs in myeloma
Normocytic normochromic
What is myeloma bone disease?
Increased osteoclast activity and suppressed osteoblast activity. Caused by cytokines released from abnormal plasma cells and other nearby cells
Common sites of myeloma bone disease are..
Skull, spine, long bones and ribs
The abnormal bone metabolism is patchy, meaning..
Bone becomes very thin in some areas while others remain relatively normal
Patches of thin bone are described as..
Osteolytic lesions
Weak points in the bone lead to __________ under minimum force
Pathological fractures
Increased osteoclast activity causes calcium reabsorption from the bone into the blood, resulting in..
Hypercalcaemia
What are Plasmacytomas?
Individual tumours formed by cancerous plasma cells
They can occur in the bones, replacing normal bone tissue, or in the soft tissues
Patients with myeloma often develop renal impairment. What can cause this?
Paraproteins
Hypercalcaemia
Dehydration
Glomerulonephritis
Medications used to treat the condition
What is the normal viscosity in blood flow?
Between 1.3 and 1.7 times of water (blood is thicker than water)
Plasma viscosity increases when..
There are more proteins are in the blood, such as the paraproteins found in myeloma
Hyperviscosity syndrome is considered an emergency. It can cause many issues such as..
Bleeding (e.g., nosebleeds and bleeding gums)
Visual symptoms and eye changes (e.g., retinal haemorrhages)
Neurological complications (e.g., stroke)
Heart failure
Risk factors for Hyperviscosity Syndrome
Older age
Male
Black ethnic origin
Family history
Obesity
Ix for myeloma
Bloods
Protein electrophoresis
Bone marrow aspiration
Whole-body MRI/X-rays
What type of blood tests are done into myeloma?
FBC: anaemia
Peripheral blood film: rouleaux formation
Urea and electrolytes: renal failure
Bone profile: hypercalcaemia
Protein electrophoresis results that would indicate myeloma
Bence Jones proteins - raised concentrations of monoclonal IgA/IgG proteins
Bone marrow aspiration confirms the diagnosis of myeloma if the number of ________ is significantly raised
Plasma cells
What does the x-ray show?
‘Rain-drop skull’ seen in myeloma
What would be a differential for rain drop skull seen in myeloma?
‘Pepperpot skull’ seen in primary hyperparathyroidism
Diagnostic criteria for myeloma
One major and one minor criteria or three minor criteria if has signs or symptoms of multiple myeloma
Major criteria for myeloma
Plasmacytoma (as demonstrated on evaluation of biopsy specimen)
30% plasma cells in a bone marrow sample
Elevated levels of M protein in the blood or urine
Minor criteria for myeloma
10% to 30% plasma cells in a bone marrow sample
Minor elevations in the level of M protein in the blood or urine
Osteolytic lesions
Low levels of antibodies (not produced by the cancer cells)
Define myeloma
Plasma cell proliferation due to genetic mutations which occur as B-lymphocytes differentiate into mature plasma cells
Tx for myeloma
Combination of chemotherapy:
Bortezomib (a proteasome inhibitor)
Thalidomide
Dexamethasone
High-dose chemotherapy followed by a stem cell transplant is an option for fitter patients and may achieve a more extended period of remission. Stem cell transplantation can be..
Autologous (using the person’s own stem cells)
Allogeneic (using stem cells from a healthy donor)
