Myeloma

Question 1

What is multiple myeloma?

Answer 1

• disease of plasma cells
• uncontrolled plasma cell replication leads to immunoglobulin spike
• clones accumulate and cause suppression of bone marrow

Question 2

Myeloma presentation

Answer 2

• renal failure - SOB, oedema
• anaemia + thrombocytopaenia
• bone pain often in spine, ribs
• uraemia causing N&V, weight loss
• pruritus and muscle cramping due to high phosphate
• fever, dysuria, rash, confusion, neuropathy

Question 3

Myeloma investigations

Answer 3

• FBC - anaemia, neutropenia, thrombocytopaenia
• U&Es - raised creatinine, hypercalcaemia
• ESR - raised
• blood film - roleaux formation
• immunoglobluin measurements
• protein electrophoresis (Bence Jones)
• serum free light chains
• skeletal survey but MRI is gold standard to find extent of myeloma (lytic lesions)
• TREPHINE biopsy

Question 4

Myeloma diagnosis

Answer 4

• clonal plasma cells >10% on bone marrow
• paraprotein in serum or urine
• plasma cell related end-organ damage
• smouldering myeloma - watch + wait
• MGUS - monitor, 1% progression risk

Question 5

Myeloma management

Answer 5

• patient under 65 - induction chemo (Bortezomib + dexa) followed by autologous stem cell transplant
• patient over 65 - chemo alone (Thalidomide + alkylating agent + dexa)
• maintenance chemotherapy
• relapse is common
• treatment resistance may develop
• manage bone pain with bisphosphonates, radiotherapy