Myeloma Flashcards
What is it?
Multiple myeloma (MM) is a haematological malignancy characterised by plasma cell proliferation.
It arises due to genetic mutations which occur as B-lymphocytes differentiate into mature plasma cells.
Clinical features
age
The median age at presentation is 70-years-old.
Use the pneumonic [CRABBI]:
CALCIUM
- Hypercalcaemia occurs as a result of increased osteoclast -activity within the bones
- CF: constipation, nausea, anorexia and confusion
RENAL impairment caused by:
- Monoclonal production of immunoglobulins results in light chain deposition within the renal tubules
- Amyloidosis
ANAEMIA
- Bone marrow crowding suppresses erythropoiesis leading to anaemia
- CF: fatigue and pallor
BLEEDING
- Bone marrow crowding also results in thrombocytopenia which puts patients at increased risk of bleeding and bruising
BONES
- Bone marrow infiltration by plasma cells and cytokine-mediated osteoclast overactivity creates lytic bone lesions
- CF: back pain and increased risk of fragility fractures
INFECTION
- a reduction in the production of normal immunoglobulins results in increased susceptibility to infection
Investigation
FBC: anaemia and thrombocytopenia (FBC)
U+Es: raised urea and creatinine (U&E) and raised calcium
SERUM & URINE PROTEIN ELECTROPHORESIS:
- raised concentrations of monoclonal IgA/IgG proteins will be present in the serum
- In the urine, they are known as Bence Jones proteins
BLOOD FILM:
- rouleaux formation
BONE MARROW ASPIRATION + TREPHINE BIOPSY: - confirms the diagnosis if the number of plasma cells is significantly raised ( >10% )
WHOLE BODY MRI(or CT if MRI is not suitable) is used to survey the skeleton for bone lesions
A common X-ray finding is a ‘rain-drop’ skull. This is numerous randomly placed dark spots seen on X-ray which occur due to bone lysis.
Management
Autologous stem cell transplant is removal of a patient’s own stem cells prior to chemotherapy, which are then replaced after chemotherapy
For patients who are suitable for autologous stem cell transplantation induction therapy consists of:
Bortezomib + Dexamethasone
For patients who are unsuitable (old, co-morbidities) for autologous stem cell transplantation, induction therapy consists of :
Thalidomide + an Alkylating agent + Dexamethasone