Myeloma Flashcards
What is Myeloma
Cancer of the plasma cells - B lymphocyte that produce antibodies
Multiple myeloma is where the myeloma affects multiple areas of the body
Monoclonal gammopathy of undetermined significance (MGUS)
Excess of a single type of antibody or antibody components without other features of myeloma
May progress to myeloma and patients are often followed up routinely
Smouldering myeloma
Progression of MGUS with higher levels of antibodies or antibody components
Premalignant and more likely to progress to myeloma than MGUS
Waldenstrom’s macroglobulinemia
Type of smouldering myeloma where there is excessive IgM specifically
Which immunoglobulin is most commonly affected in myeloma?
IgG (>50%)
What protein in urine is seen in myeloma?
Bence Jones
How does anaemia occur in myeloma?
Plasma cells invade the bone marrow
Causes suppression of the development of other blood cell lines
anaemia
neutropenia thrombocytopenia
Myeloma bone disease
Increased osteoclast activity
Suppressed osteoblast activity
More bone (+calcium) is being reabsorbed than constructed
Caused by cytokines released from the plasma cells and the stromal cells
Common sites of bone disease
Skull
Spine
Long bones
Ribs
What are plasmacytomas?
Individual tumours made up of the cancerous plasma cells
In bones or in soft tissue
Why do myeloma patients get renal impairment?
High levels of immunoglobulins (antibodies) can block the flow through the tubules
Hypercalcaemia
Dehydration
Medications used to treat the conditions such as bisphosphonates can be harmful to the kidneys
Key features of myeloma
C – Calcium (elevated)
R – Renal failure
A – Anaemia (normocytic, normochromic) from replacement of bone marrow.
B – Bone lesions/pain
RF for myeloma (5)
Older age
Male
Black African ethnicity
Family history
Obesity
Initial investingations in myeloma
Consider myeloma in 60+ with persistent bone pain, particularly back pain, or an unexplained fractures
FBC (low white blood cell count in myeloma) Calcium (raised in myeloma) ESR (raised in myeloma) Plasma viscosity (raised in myeloma)
What is used to conform the diagnosis?
Bone marrow biopsy
Signs of myeloma on xray
Punched out lesions
Lytic lesions
“Raindrop skull” caused by many punched out (lytic) lesions throughout the skull that give the appearance of raindrops splashing on a surface
Investigating when myeloma suspected
B – Bence–Jones protein (request urine electrophoresis)
L – Serum‑free Light‑chain assay
I – Serum Immunoglobulins
P – Serum Protein electrophoresis
Management of myeloma
Aim of treatment is to control disease
First line treatment usually involves a combination of chemotherapy with:
Bortezomid
Thalidomide
Dexamethasone
Management of myeloma bone disease
Myeloma bone disease can be improved using bisphosphonates - suppress osteoclast activity
Radiotherapy to bone lesions can improve bone pain
Orthopaedic surgery can stabilise bones (e.g. by inserting a prophylactic intramedullary rod) or treat fractures
Cement augmentation involves injecting cement into vertebral fractures or lesions and can improve spine stability and pain
Complications with myeloma
Infection
Pain
Renal failure
Anaemia
Hypercalcaemia
Peripheral neuropathy
Spinal cord compression
Hyperviscocity
