Myeloma

Question 1

Myeloma Definition

Answer 1

• Malignant proliferation of plasma cells
• Diffuse bone marrow infiltration causing bone destruction and bone marrow failure
• Overproduction of a monoclonal antibody
• Osteolytic bone lesions, renal disease and immunodeficiency
• IgG is most common
• Almost all evolve from MGUS, MGUS progresses at 1% per year
• Sometimes intermediate asymptomatic but more advanced pre-malignant stage called smouldering

Question 2

Myeloma Presentation

Answer 2

• Wide range including hypercalcaemia, renal impairment, anaemia, bone pain (CRAB)
• Fractures, back ache
• Cord compression
• Lethargy
• Anorexia
• Dehydration
• Recurrent bacterial infection
• Features suggesting amyloidosis
• Admit immediately if cord compression, AKI or hypercalcaemia

Question 3

Myeloma Ix

Answer 3

• FBC, ESR, U&Es, calcium, albumin, uric acid
• Bone marrow aspiration is diagnostic test
• Skeletal survey
• Serum and urine protein electrophoresis to show type of paraprotein and Bence Jones’
• Quantitive immunoglobulin levels
• Plain X-ray of symptomatic areas

Question 4

Myeloma Diagnostic Criteria

Answer 4

• High prevalence of MGUS most people will have this
• Criteria have been set to distinguish
• All three of below are needed for diagnosis of myeloma
• Monoclonal plasma cells in marrow >10%, monoclonal protein in serum or urine, evidence of myeloma related organ or tissue impairment (any of CRAB features)

Question 5

Myeloma Differentials

Answer 5

• MGUS
• Amyloid light-chain amyloidosis
• B-cell non-Hodgkin’s lymphoma
• CLL

Question 6

Myeloma Management

Answer 6

Incurable disease that is chronic relapsing and remitting

• Treatment aims to control disease, prolong survival and maximise quality of life
• Induction
• Prevent bone disease
• Prevent DVT
• Prevent infection (vaccinations)
• Manage neuropathy and thrombosis

Question 7

Myeloma Prognosis

Answer 7

• Prognosis is improving

- Prognosis not good