Myeloma

Question 1

What is myeloma? what are it’s symptoms??

Answer 1

-Cancer of the bone marrow plasma cells (differentiated B cells)
-CRAB:
Calcaemia of the hyper variety
Renal impairment
Anaemia
Bone lesions/diease - pathological fracture/osteoporosis/pain

+others - paraprotein production, infection, neuropathy, lethargy, hypervicossity, macroglossia

Question 2

What will patients with myeloma actually present with?

Answer 2

• chronic back pain/pathological fractures - osteolytic lesions
• recurrent infections
• symptomatic hypercalcaemia (bones, groans, stones, moans)
• Sx of anaemia

Question 3

What’s the criteria for a multiple myeloma diagnosis?

Answer 3

-1 major + 1 minor criteria OR 3 minor criteria (have to have sx too)

Major:

• plasmacytoma (biopsied bone lesion)
• 30% plasma cells in bone marrow
• elevated myeloma protein in blood or urine

Minor:

• 10-30% plasma cells in marrow sample
• minor elevation in myeloma protein in blood or urine
• osteolytic lesions on imaging
• low levels of non-cancerous antibodies

Question 4

Who do you treat? and how do you treat?

Answer 4

• ONLY TREAT SYMPTOMATIC PATIENTS
• candidate for stem cell transplant - induction then stem cell transplant
• not candidate for SCT - intensive meds - thalidomide + dexamethasone

+ supportive tx, bisphosphonates, EPO/transfusions for anaemia

Question 5

Who gets stem cell transplant?

Answer 5

• under 50
• fit and well prior to myeloma
• early stage of disease

Question 6

What is MGUS? How is it related to asymptomatic myeloma? How are they both managed?

Answer 6

• monocloncal gammopathy of undetermined significance
• both asymptomatic and MGUS get monitored for progression to symptomatic myeloma
• MGUS may have demyelinating neuropathy

Question 7

How can you differentiate between MGUS and myeloma?

Answer 7

MGUS=

• normal immune function
• normal beta-2 macroglobulin levels
• lower paraproteinaemia
• stable paraproteinamia
• no Sx of myeloma