Myeloma

Question 1

What is Myeloma?

Answer 1

Malignant proliferation of a single clone of plasma cells, leading to secretion of immunoglobulin that can cause the dysfunction of many organs

Question 2

What age group and ethnicity is Myeloma most likely to present in?

Answer 2

70 years old

Afro-Caribbean

Question 3

What is the clinical presentation of Myeloma?

Mnemonic - CRABBI

Answer 3

=> C - Calcium

• Hypercalcaemia occurs as a result of increased osteoclast activity
• Leads to constipation, nausea, anorexia, confusion

=> R - Renal

• Monoclonal production of immunoglobulins results in light chain deposition within the tubules
• Results in renal damage, which can cause dehydration and thirst

=> A - Anaemia

• Bone marrow crowding suppresses erythropoiesis
• Less RBCs produced therefore anaemia

=> B - Bleeding

• Decreased production of platelets
• Easy bleeding and bruising

=> B - Bones

• Osteolytic bone lesions can lead to fragility fractures, back pain

=> I - Infection

• Reduction in production of normal immunoglobulins
• Increased susceptibility to infection

Question 4

What are the investigations in suspected Myeloma?

Answer 4

=> Bloods

• Anaemia and thrombocytopenia
• Hypercalcaemia
• Raised U&Es due to dehydration

=> Serum or urine electrophoresis - diagnostic

• Raised IgG or IgA levels in serum
• Urine shows Bence Jones proteins

=> Bone marrow biopsy:
- Increased plasma cells levels

=> Skull X-ray
- Rain drop (random black spots due to bone lysis)

Question 5

What is the diagnostic criteria for Myeloma?

Answer 5

• Monoclonal plasma cells in bone marrow biopsy > 10%
• Monoclonal protein within serum or urine
• Evidence of end organ damage (hypercalcaemia, renal insufficiency, or anaemia)
• Bone lesions

Question 6

What is the management of Myeloma?

Answer 6

=> Not curable, management focuses on symptoms relief

=> Supportive:

• Analgesia
• Transfusion for cases of anaemia
• Rehydration and adequate fluid intake for kidney failure
• Treat rapidly with broad spectrum antibiotics for cases of infection

=> Chemotherapy:

• Determine if fit for autologous stem cell transplantation
• If YES => Bortezomib + Dexamethasone
• If NO => Thalidomide + an Alkylating agent + Dexamethasone

=> Patient followed up after 3 months

Question 7

What are the complications of Myeloma and how are they managed?

Answer 7

=> Pain:
- Analgesia

=> Fracture:
- Bisphosphonates

=> Infection:
- Annual influenza vaccine

=> VTE prophylaxis