Myeloma Flashcards
What is myeloma
Abnormal monoclonal proliferation of a plasma cell leading to Ig/Ig fragment secretion which can accumulate and cause organ dysfunction
Generally in 70+
Myeloma classification
Depends on paraprotein produced: IgG, IgA, rarely (IgM, IgD), light chain only
Myeloma clinical features
Pancytopenia due to marrow infiltration of plasma cells
Renal impairment from light chain deposition
Osteolytic bone lesions
Hypercalcaemia from osteoclast activation by myeloma cells
Raised ESR from raised protein in blood
CRAB features of end-organ damage (Calcium up, Renal dysfunction, Anaemia, Bone disease)
Myeloma diagnostic tests
Serum + urine paraprotein by electrophoresis (Bence-Jones proteins in urine)
Evaluation of lytic bone lesions with whole body MRI (gold standard) or whole body low dose (PET/)CT
Bone marrow plasma cells >10% from biopsy
Rouleaux formation seen in blood film due to inc protein
Myeloma supportive treatment
Bone pain - analgesia + bisphosphonate
Anaemia - transfusion ± Epo
Renal failure - rehydrate + dialysis in AKI
Infections - broad spec Abs + regular IVIg if needed
Myeloma treatment
Lenalidomide, bortezomib + dexamethasone until remission then autologous stem cell transplant in <65-70
Continue chemo if transplant unsuitable until paraprotein plateau then stop until rise again
Beware lenalidomide SEs (neutropenia/thromboembolism)
Myeloma complications
Hypercalcaemia - rehydrate with saline, IV bisphosphonates acutely
Spinal cord compression due to vertebral collapse
Hyperviscosity - plasmaphoresis to remove light chains
AKI
What is MGUS
Monoclonal gammopathy of undetermined significance
Myeloma with some monoclonal protein, no CRAB features and no bone marrow involvement
Can develop into myeloma
Paraproteinaemia categories
Myeloma
MGUS
Waldenstrom’s macroglobulinaemia (monoclonal IgM)
Primary amyloidosis
Lymphoma/leukaemia
Heavy chain disease (may progress to lymphoma)
