Myeloma

Question 1

What is multiple myeloma?

Answer 1

Malignancy characterised by plasma cell proliferation, arises due to genetic mutations which occur as B-lymphocytes differentiate into mature plasma cells

Question 2

What is the typical age of presentation of myeloma?

Answer 2

Median age 70

Question 3

What is the presentation of myeloma? Uses the mneumnic CRABBI

Answer 3

CRABBI

*Calcium
>Hypercalacaemia occurs as a result of osteoclast activity
>leads to constipationa, nausea, anorexia and confusion

*Renal
>Monoclonal production of Ig results in deposition in tubules
>renal damage = dehydration and increasing thirst

*Anaemia
>Bone marrow crowding suppresses erythropoiesis leading to anaemia
>Causes fatigue and pallor

*Bleeding
>bone marrow crowding causes thrombocytopenia

*Bones
>Bone infiltrate by plasma cells and osteoclast overactivity = lytic bone lesions
>pain in bones, back pain

*Infection
>reduction of production of normal Ig increased susceptibility to infection

Question 4

What are the investigations done if myeloma is suspected?

Answer 4

• Bloods: anaemia, thrombocytopenia, raised Urea and creatinine and raised calcium
• Peripheral blood film
• Serum or urine electrophoresis: raised conc. of monoclonal IgA/IgG
• Bone marrow aspiration and trephine biopsy
• Whole body MRI/CT

Question 5

What is the prognosis of myeloma?

Answer 5

*Chronic relapsing and remitting malignancy which is currently deemed incurable

Question 6

What is the management of myeloma?

Answer 6

*management is to control symptoms, reduce complications and prolong survival
*induction therapy
>chemo
>stem cell transplant
>dexamthesone

Question 7

What are the possible complications of myeloma?

Answer 7

• Pain
• pathological fracture
• infection
• VTE
• fatigue