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?
CRABBI stands for Calcium, Renal, Anaemia, Bleeding, Bones, and Infection.
What is the primary cause of hypercalcaemia in multiple myeloma?
Hypercalcaemia is primarily due to increased osteoclastic bone resorption caused by local cytokines released by the myeloma cells.
What are the symptoms associated with hypercalcaemia?
Symptoms include constipation, nausea, anorexia, and confusion.
How does multiple myeloma affect renal function?
Monoclonal production of immunoglobulins results in light chain deposition within the renal tubules, causing renal damage.
What are common presentations of renal impairment in myeloma?
Common presentations 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 effect of bone marrow crowding on bleeding risk?
Bone marrow crowding results in thrombocytopenia, increasing the risk of bleeding and bruising.
What causes lytic 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 lytic bone lesions?
Symptoms may include pain (especially in the back) and an increased risk of pathological fractures.
How does multiple myeloma affect infection risk?
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 significance 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?
Imaging techniques include skeletal surveys, whole-body MRI, and X-rays (notably ‘rain-drop skull’).
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 the 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, chemotherapy, and steroids.
What are examples of targeted drugs for myeloma?
Examples include thalidomide, lenalidomide, bortezomib, and daratumumab.
What are examples of chemotherapy drugs for myeloma?
Examples include cyclophosphamide and melphalan.
What is autologous hematopoietic cell transplantation?
It involves the removal of a patient’s own stem cells prior to chemotherapy, which are then replaced after chemotherapy.
What are the benefits of autologous hematopoietic cell transplantation?
It prolongs both event-free and overall survival when compared with non-transplant strategies.
Who is typically suitable for stem cell transplantation?
Typically, it is younger, healthier patients who are suitable for stem cell transplantation and rigorous chemotherapy regimes.
Why is allogenic hematopoietic cell transplantation not commonly used in myeloma?
Due to high rates of overall mortality and symptoms of graft-versus-host disease.
What complications are managed in multiple myeloma treatment?
Complications include pain, pathological fractures, infection, venous thromboembolism, and fatigue.
How is pain managed in multiple myeloma?
Pain is treated with analgesia using the WHO analgesic ladder.
What is given to prevent and manage osteoporosis in myeloma patients?
Zoledronic acid is given to prevent and manage osteoporosis and fragility fractures.
What vaccinations do myeloma patients receive?
Patients receive annual influenza vaccinations.
What therapy may myeloma patients receive for infection management?
They may receive Immunoglobulin replacement therapy.
What is done for venous thromboembolism prophylaxis in myeloma patients?
Venous thromboembolism prophylaxis is provided.
How is fatigue managed in myeloma patients?
All possible underlying causes are treated, and if symptoms persist, consider an erythropoietin analogue.
