Myeloma

Question 1

describe the treatment of myeloma.

Answer 1

induction therapy;

• if suitable for autologous SCT: Bortezomib + dexamethasone
• if not suitable: Thalidomide + ankylating agent + dexamethasone

treatment of complications;

• bone = Zolendronic acid
• infection = annual influenza +/- immunoglobulin replacement
• VTE prophylaxis
• fatigue = treat underlying cause but if persists try erythropoeitin analogue e.g. Elpoeitin alfa (EPO)

Question 2

if a patient with myeloma relapses how is this treated?

Answer 2

Bortezomib monotherapy

Question 3

what are the diagnostic criteria for myeloma?

Answer 3

monoclonal antibody present in the serum/urine (bence jones protein) as evident by protein electrophoresis

bone marrow biopsy > 10% plasma cells

end-organ damage e.g. hypercalcaemia, anaemia, lytic bone lesions

Question 4

what investigations would you carry out to diagnose myeloma and what would they show?

Answer 4

FBC: anaemia
U&E: increased urea and creatinine
Clacium: increased

serum/urine protein electrophoresis: significant abundance of IgG or IgA (bence jones protein in urine)

bone marrow aspiration and trephine biopsy ( >10% plasma cells)

who body MRI: lytic bone lesions

Question 5

what feature of a head x-ray is found in myeloma?

Answer 5

‘rain-drop’ skull

lytic bone lesions

Question 6

what is the staging of myeloma based on?

Answer 6

albumin

beta-2-microglobulin

Question 7

what are risk factors for myeloma?

Answer 7

black ethnicity

age (peak in 70s)

Question 8

what systemic/end-organ complications are associated with myeloma?

Answer 8

renal failure

• light chains deposit within tubules = renal failure
• nephrocalcinosis, nephrolithiasis
• cast nephropathy
• nephrotic syndrome (amyloidosis)

hypercalcaemia

osteoporosis

infection

VTE

fatigue and pain