Myeloma Flashcards

1
Q

What is it?

A

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.

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2
Q

Clinical features

age

A

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

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3
Q

Investigation

A

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.

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4
Q

Management

A

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

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