Myeloma Flashcards
What is myeloma?
Plasma B-lymphoid neoplasm (mature plasma cell proliferation) + antibodies
What is the most common type of myeloma?
IgG
What is the typical age for myeloma?
70
What is a risk factor for myeloma?
Afro-Caribbean
What are the signs and symptoms of myeloma?
CRABBI
- Hypercalcaemia
- Renal failure
- Anaemia
- Bone failure/disease/dysfunction + pain + Bleeding
- Infection
What are the complications of myeloma/bone failure in myeloma?
- Spinal cord compression
- Increased likelihood of fracture
How do you diagnose myeloma?
Serum/urine electrophoresis
What do you see in serum/urine electrophoresis in myeloma?
- Monoclonal bands/paraproteins
- Urine Bence Jones protein
What is a kidney complication of myeloma?
Cast nephropathy
What other investigations would you do in myeloma?
- FBC
- U&Es
- Blood film
- BM biopsy
- XR ± CT ± MRI
What would you see on a blood film in myeloma?
Rouleaux (stacking of cells like stack of coins)
What would you see on BM biopsy in myeloma?
Plasma cells
What would you see on XR in myeloma?
‘Punched-out’ lesions - lytic bone lesions in skull, long bones and spine
What is a bleeding complication of myeloma and how do you treat?
- Hyperviscosity syndrome - high levels of paraprotein increase blood viscosity, decreased oxygen delivery causing end organ dysfunction
- Symptoms = reduced cognition, disturbed vision, bleeding
- Bleeding but don’t transfuse red cells
- Treat with plasmapheresis to remove light chains
How do you treat myeloma?
- Palliative - chemo + steroids + BMT
- Lenalidomide + bortezomib + dexamethasone
- OR chemo + steroids
- Ig treatments targeted at proteins on neoplastic cells- daratumumab, ixazomib, elotuzumab
- Treat CRAB - bisphosphonates
- Autologous stem cell transplant for young people if there is remission
What type of neoplasm is myeloma?
Physical tumour e.g. in vertebra
What condition typically proceeds myeloma?
Monoclonal gammopathy of undetermined significance (MGUS)
What happens in myeloma?
Plasma cells accumulate in BM and crowd out healthy cells
What would you see in a bone marrow aspirate in myeloma?
Increased plasma cells
How do you treat hypercalcaemia?
1) IV saline
2) IV bisphosphonates e.g. zolendronate
How do you treat spinal cord compression?
PO dexamethasone + local radiotherapy
What would you see on blood tests in myeloma?
- Normocytic anaemia
- Increased urea and creatinine
- Increased calcium
- Increased ESR
