Myeloma

Question 1

Multiple myeloma is a neoplasm of which type of cell

Answer 1

Peak incidence is patients aged 60-70 years

Question 2

Clinical features of multiple myeloma

Answer 2

Bone diseas: bone pain, osteoporosis _ pathological fractures
Lethargy
Infection
Hypercalcaemia
Renal failure
Amyloidosis- Macroglossia, carpal tunnel syndrome, neuropathy, hyperviscosity

Question 3

Investigations for multiple myeloma

Answer 3

Monoclonal proteins - IGA or IgG in the serum and urine- Bence Jones proteins
Increased plasma cells in the bone marrow
Rain-drop skull

Question 4

Major criteria

Answer 4

Plasmacytoma (as demonstrated on evaluation of biopsy specimen)
30% plasma cells in a bone marrow sample
Elevated levels of M protein in the blood or urine

Question 5

Minor criteria

Answer 5

10% to 30% plasma cells in a bone marrow sample.
Minor elevations in the level of M protein in the blood or urine.
Osteolytic lesions (as demonstrated on imaging studies).
Low levels of antibodies (not produced by the cancer cells) in the blood.

Question 6

Hypercalcaemia in myeloma

Answer 6

primary factor: due primarily to increased osteoclastic bone resorption caused by local cytokines (e.g. IL-1, tumour necrosis factor) released by the myeloma cells
much less common contributing factors: impaired renal function, increased renal tubular calcium reabsorption and elevated PTH-rP levels