Myeloma

Question 1

What is multiple myeloma?

Answer 1

Malignancy of the plasma cells

The antibody producing B lymphocytes

One type of immunoglobulin is overproduced

This excess immunoglobulin is deposited in organs causing damage

Question 2

Which immunoglobulin is most commonly over-produced in myeloma?

Answer 2

Usually IgG or IgA

Question 3

Who gets multiple myeloma?

Answer 3

Elderly, peak age = 70

Question 4

Clinical features of multiple myeloma?

Answer 4

CRAB

C - hypercalcaemia
R - renal failure
A - anaemia
B - bone pain

Question 5

What causes the bone pain in multiple myeloma?

Answer 5

Bone destruction

Caused by increased osteoclastic activity

This causes osteolytic lesions

Holes/weaknesses in the bone

Question 6

What causes renal failure in multiple myeloma?

Answer 6

Deposition of protein casts in the kidney tubules

Deposition of amyloid

Hypercalcaemia and hyperuricaemia

Question 7

What causes anaemia in multiple myeloma?

Answer 7

Bone marrow infiltration with plasma cells resulting in impaired bone marrow function

anaemia, thrombocytopenia, leucopenia

Question 8

Investigations of multiple myeloma?

Answer 8

Bloods:

• normocytic normochromic anaemia
• persistent raised ESR
• thrombocytopenia
• leucopenia
• evidence of renal failure

Bone marrow:

• excess plasma cells
• excess Ig

X-ray:

• Pepper-pot skull
• punched out lesions in bone
• vertebral collapse
• fractures

Question 9

Management of multiple myeloma?

Answer 9

Chemotherapy

Radiotherapy

Stem cell transplant

Supportive:

• analgesia
• bisphosphonates to prevent fractures
• correct anaemia with transfusion, or EPO
• dialysis
• treat infections + prophylaxis

Question 10

What ultimately causes death in multiple myeloma?

Answer 10

Infection

Renal failure