Myeloma

Question 1

Define

Answer 1

Malignant proliferation of plasma cells resulting in bone marrow infiltration causing destruction and bone marrow failure

Question 2

Epidemiology

Answer 2

Second most common blood cancer
-Poor prognosis
Men
Elderly

Question 3

Clinical Features

Answer 3

Bone pain - back ache
Pathological fractures
Spinal cord compression

Anaemia = lethargy
Constitutional cancer symptoms

Question 4

INVESTIGATIONS

Answer 4

BLOODS
Hb –
MCV normal (normocytic normochromic)
Ca2+ ++ (breakdown of bone)
Urea/Creatinine ++ (IgG paraproteins deposited in small vessels so renal disease)
IgG ++ (but low other Ig because of bullying)

IMAGING
X-RAY symptom areas

OTHER
Electrophoresis for BENCE JONES in urine
Electrophoresis for PARAPROTEINS in blood
Bone marrow aspirate*
Skeletal survey

Question 5

Management

Answer 5

Fluids

Analgesia (avoid NSAIDs = renal failure)
Steroids
Chemotherapy + allopurinol to prevent tumour lysis
Bisphosphonates

Potential stem-cell transplant in younger patients