Myeloma Flashcards
What is multiple myeloma?
a malignant disease of the plasma cells of bone marrow, accounting for 1% of all malignant disease
In multiple myeloma there is clonal proliferation of what?
bone marrow plasma cells, usually capable of producing monoclonal immunoglobulins (paraproteins), which in most cases are IgA or IgG
what is paraproteinaemia and what sign is it associated with?
a.k.a monoclonal gammopathy
the presence of excessive amounts of paraprotein or single monoclonal gammaglobulin in the blood
excretion of light chains in the urine (Bence Jones protein) which are either kappa or lambda
whats the peak age of presentation?
60 years
how does bone destruction manifest clinically?
increased osteoclastic activity causes bone pain (back ache being the most common presenting symptom)
osteolytic lesions
pathological fractures
spinal cord compression
hypercalaemia
how does bone marrow infiltration manifest clinically?
results in anaemia, infections and bleeding
what causes acute kidney injury?
multiple causes:
deposition of light chains in the tubules
hypercalcaemia
hyperuricaemia
amyloid deposition
what do aggregates of paraproteins in the blood lead to?
they greatly increase the viscosity –> blurred vision, gangrene and bleeding
what are increased infections due to?
reduction in the normal polyclonal immunoglobulin levels (immune paresis)
2 out of 3 diagnostic features should be present, what are they?
paraproteinaemia on serum protein immunofixation or Bence Jones protein in the urine
Radiological evidence (CT, MRI) of lytic bone lesions
Increase in bone marrow plasma cells on bone marrow aspirate or trephine biopsy
2 other essential investigations
blood count: may show anaemia, thrombocytopenia and leucopenia. ESR is almost always high
serum biochemistry may show evidence of renal failure and hypercalaemia
median survival?
5 years with good supportive care and chemo with autologous stem cell transplant
supportive therapy
correction of anaemia with blood transfusion or EPO
prompt Tx of infections
Tx of bone pain with radiotherapy or high-dose dexamethasone
AKI and hypercalceamia may be corrected with adequate hydration alone
how is hyper viscosity treated?
plasma pheresis (liquid in the blood, or plasma, is separated from the cells), together with systemic therapy
specific Tx (involves combination chemo)
melphalan (an alkylating agent), prednisolone and thalidomide
