Myeloma Flashcards
What is Multiple myeloma
Malignant neoplasm of (bone marrow) plasma cells
Pathophysiology of Multiple Myeloma
Clonal proliferation of bone marrow cells, usually capable of monoclonal antibodies (usually IgA or IgG). Can be associated with the excretion of light chains in the urine (Bence Jones protein).
Bone destruction: increased osteoclastic activity -> bone pain and osteolytic lesions Infiltration of bone marrow -> reduced function
AKI: due to light chain and amyloid deposition, hypercalcaemia and hyperuricaemia.
Paraproteins: Can aggregate in the blood to greatly increase viscosity
Aetiology of Multiple Myeloma
Mutation.
About half of the cases = translocation placing oncogene into immunoglobulin heavy chain gene on chromosome 14
When is peak presentation of Multiple myeloma
60 years
Diagnostic tests of Multiple myeloma
Paraproteinaemia
Bence Jones protein in urine
CT
Bone marrow aspirate
Treatment of Multiple myeloma
Chemotherapy with autologous stem cell transplant Paraprotein: plasmapheresis Blood transfusion for anaemia Treatment of infection AKI can be treated by hydration
Complications of multiple myeloma
Spinal cord compression Pathological feature Hypercalcaemia AKI Increased risk of infection Anaemia Terminal With treatment, median survival in 5 years
Signs and symptoms
Fatigue Unintentional weight loss Pathological fractures Vertebral collapse (may lead to spinal cord compression) Hypercalcaemia Anaemia Infection Renal impairment Bruising
Investigations
Bloods Blood film (rouleaux formation) Serum and urine electrophoresis Bone marrow biopsy Radiology
Blood investigations
FBC, U and Es, Creatinine, LFTs, ESR, CRP,
Calcium levels,
Alkaline phosphatase,
Beta-2 microglobulin
What type of anaemia would you seen in myeloma
Normocytic, normochromic
Serum and urine electrophoresis investigations
Paraprotein (M protein)
Bence Jones proteinuria
Radiological investigations
X-ray for bone deformities e.g. pepper pot skull and generalised skeletal osteopenia
MRI scan may be useful
Conservative treatment
Patient education
Refer to Macmillan nurses
Surgical treatment
Kyphoplasty may be required
Medical treatment
<70 and without significant co-morbidities
(Treatment depends on age of patient and their state of health)
Eligible for Autologous Bone Marrow Transplant (most effective treatment):
This involves induction phase using VAD regimen and after transplant, the patient receives long-term therapy with melphalan
Medical treatment
if not legible for autologous bone marrow transplant
Long term treatment with melphalan and prednisolone
Other medical treatments (not bone marrow transplants)
Analgesia Bisphosphonates Prednisolone Blood transfusion Radiotherapy may be required to treat bone pain and spinal cord compression
Define monoclonal paraprotein
One immunoglobulin which is excessively produced
Which electrolyte is raised in patients with myeloma
calcium
How much fluid should myeloma patients drink/day
3L/day
