Myeloma Flashcards
What is multiple myeloma (MM)?
Multiple myeloma (MM) is a haematological malignancy characterised by plasma cell proliferation.
What is the median age at presentation for multiple myeloma?
The median age at presentation is 70 years old.
What does the mnemonic CRABBI stand for in multiple myeloma features?
CRABBI stands for Calcium, Renal, Anaemia, Bleeding, Bones, Infection.
What causes hypercalcaemia in multiple myeloma?
Hypercalcaemia is due primarily to increased osteoclastic bone resorption caused by local cytokines released by the myeloma cells.
What are the symptoms associated with hypercalcaemia in multiple myeloma?
Symptoms include constipation, nausea, anorexia, and confusion.
How does renal impairment occur in multiple myeloma?
Monoclonal production of immunoglobulins results in light chain deposition within the renal tubules, causing renal damage.
What are the symptoms of renal impairment in multiple myeloma?
Symptoms include dehydration and increasing thirst.
What causes anaemia in multiple myeloma?
Bone marrow crowding suppresses erythropoiesis, leading to anaemia.
What are the symptoms of anaemia in multiple myeloma?
Symptoms include fatigue and pallor.
What is the cause of bleeding in multiple myeloma?
Bone marrow crowding results in thrombocytopenia, increasing the risk of bleeding and bruising.
What causes bone lesions in multiple myeloma?
Bone marrow infiltration by plasma cells and cytokine-mediated osteoclast overactivity creates lytic bone lesions.
What are the symptoms associated with bone lesions in multiple myeloma?
Symptoms may present as pain (especially in the back) and increase the risk of pathological fractures.
How does multiple myeloma affect infection susceptibility?
A reduction in the production of normal immunoglobulins results in increased susceptibility to infection.
What are some other features of multiple myeloma?
Other features include amyloidosis (e.g., macroglossia), carpal tunnel syndrome, neuropathy, and hyperviscosity.
What blood tests are used in the investigation of multiple myeloma?
Blood tests include full blood count (anaemia), peripheral blood film (rouleaux formation), urea and electrolytes (renal failure), and bone profile (hypercalcaemia).
What does protein electrophoresis reveal in multiple myeloma?
It shows raised concentrations of monoclonal IgA/IgG proteins in the serum and Bence Jones proteins in the urine.
What is the purpose of bone marrow aspiration in multiple myeloma?
Bone marrow aspiration confirms the diagnosis if the number of plasma cells is significantly raised.
What imaging techniques are used in the investigation of multiple myeloma?
Historically, a skeletal survey was used, but whole-body MRI is now recommended. X-rays may show a ‘rain-drop skull’ pattern.
What are the major diagnostic criteria for multiple myeloma?
Major criteria include plasmacytoma, 30% plasma cells in a bone marrow sample, and elevated levels of M protein in blood or urine.
What are the minor diagnostic criteria for multiple myeloma?
Minor criteria include 10% to 30% plasma cells in a bone marrow sample, minor elevations in M protein, osteolytic lesions, and low levels of antibodies in blood.
What is multiple myeloma (MM)?
Multiple myeloma (MM) is a haematological malignancy characterised by plasma cell proliferation.
How does multiple myeloma arise?
It arises due to genetic mutations which occur as B-lymphocytes differentiate into mature plasma cells.
What is the management goal for myeloma?
Management aims to control symptoms, reduce complications and prolong survival.
What types of drugs are used in the treatment of myeloma?
A combination of drugs is used, including:
- Induction therapy
- Targeted drugs (such as thalidomide, lenalidomide, bortezomib, daratumumab)
- Chemotherapy (such as cyclophosphamide or melphalan)
- Steroids (such as prednisolone or dexamethasone)
