myeloma

Introduction

  • A malignant proliferation of plasma cells within the bone marrow, resulting in lytic lesions and production of monoclonal immunoglobulin


Epidemiology

  • Second commonest haematological cancer
  • Median age at diagnosis = 71 years
  • 6-7/100 000 per year new cases
  • Median survival 50-55 months


Presentation

  • Most commonly with features of hypercalcaemia (delirium, polydipsia, polyuria, abdominal pain, constipation)
  • Fragility fractures


History



Bedside tests

Urine dipstick



Laboratory investigations

Blood investigations

  • Plasma calcium - is there hypercalcaemia?
  • U&Cr - is there renal impairment?
  • ALP - usually normal
  • Serum free light chains
  • Beta-2 microglobulin

Urine investigations

  • Urine electrophoresis - are Bence-Jones proteins present?

Radiological investigations

  • XR and CT may identify


Diagnostic criteria

The diagnostic criteria for multiple myeloma requires one major and one minor criteria or three minor criteria in an individual who has signs or symptoms of multiple myeloma.

Major criteria
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

Minor criteria
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.

Management

Immediate management

Second line



Ongoing management

Prior to discharge

  • eg education / medication review

Follow up

  • Monitoring blood tests, imaging or clinic follow up

Complications

Hyperviscosity syndrome

Fragility fractures

Renal failure (light chain nephropathy)

Amyloidosis (type AL)

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