Myeloma

• What is multiple myeloma characterized by?


  Proliferation of abnormal plasma cells in the bone marrow
• What do abnormal plasma cells in multiple myeloma secrete?


  Monoclonal antibodies and antibody fragments
• What condition results from a relative deficiency of functional antibodies in multiple myeloma?


  Relative hypogammaglobulinaemia
• What are some systemic symptoms caused by multiple myeloma?


  Bone destruction, kidney dysfunction, and anaemia
• Who does multiple myeloma primarily affect?


  Older adults
• What factors are associated with multiple myeloma?


  Genetic and environmental factors
• What is the primary goal of managing multiple myeloma?


  To control the disease and improve overall survival
• What is the definition of multiple myeloma?


  A plasma cell dyscrasia characterized by abnormal clonal proliferation of plasma cells
• What percentage of all cancers does multiple myeloma account for?


  Approximately 1%
• What is the median age at diagnosis for multiple myeloma?


  Around 69 years
• Which demographic is affected twice as frequently by multiple myeloma?


  Individuals of Afro-Caribbean descent
• What are some risk factors associated with the development of multiple myeloma?


  Genetic predisposition, exposure to radiation, and immunosuppressive conditions
• What mnemonic can be used to remember the clinical features of multiple myeloma?

  • CRAB HAI:
  • HyperCalcaemia
  • Renal impairment
  • Anaemia
  • Bone pathology
  • Hyperviscosity
  • Amyloidosis (AL subtype)
  • Infection
• What causes hypercalcaemia in multiple myeloma?


  Increased osteoclast-mediated bone resorption
• What are the symptoms associated with hypercalcaemia in multiple myeloma?


  Moans, stones, groans, and psychiatric moans
• What causes renal impairment in multiple myeloma?


  Light chain deposition in the kidneys and hypercalcaemia
• What other cytopenias can occur due to marrow infiltration by the tumor in multiple myeloma?


  Thrombocytopenia and leukopenia
• What is a common symptom of bone pathology in multiple myeloma?


  Back pain
• What type of lesions are common in multiple myeloma?


  Osteolytic lesions
• What can hyperviscosity in multiple myeloma present with?


  Headache, visual disturbance, and thrombosis
• What is the AL subtype of amyloidosis associated with in multiple myeloma?


  Cardiac failure and neuropathy
• Why do patients with multiple myeloma have an increased risk of infections?


  Due to leukopenia and immunoparesis
• What are the differential diagnoses for multiple myeloma?


  • Monoclonal Gammopathy of Undetermined Significance (MGUS)
  • Waldenström Macroglobulinaemia
  • Amyloidosis
• What characterizes Monoclonal Gammopathy of Undetermined Significance (MGUS)?


  Presence of M-proteins and typically asymptomatic
• How does Waldenström Macroglobulinaemia differ from multiple myeloma?


  It predominantly affects B cells and presents with hyperviscosity syndrome
• What causes amyloidosis in contrast to multiple myeloma?


  Deposition of abnormal protein fibers rather than proliferation of plasma cells
• What are the types of investigations for multiple myeloma?


  • Work-up investigations
  • Diagnostic investigations
  • Investigations to inform prognosis
• What might a full blood count (FBC) show in multiple myeloma?


  Anaemia
• What does a U&E test show in multiple myeloma?


  Renal impairment and/or hypercalcaemia
• What does a raised ESR indicate in multiple myeloma?


  Increased protein levels affecting red blood cell behavior
• What findings are typically seen in a skeletal survey for multiple myeloma?


  Osteolytic bone lesions and pathological fractures
• What does serum and/or urine electrophoresis show in multiple myeloma?


  A paraprotein spike, typically IgG
• What is the significance of the serum free light chain assay in multiple myeloma?


  It can show high levels in myeloma and is useful in nonsecretory cases
• How is myeloma confirmed through tissue diagnosis?


  By finding >10% plasma cells in the bone marrow
• What are the acute emergencies that can present in myeloma?


  • Acute renal failure
  • Hypercalcaemia
  • Hyperviscosity
  • Spinal cord compression
• What is critical for the treatment of acute renal failure in myeloma?


  Swift treatment of volume depletion
• What is needed to treat hypercalcaemia in myeloma?


  Fluid and bisphosphonates
• What is required for treating hyperviscosity in myeloma?


  Plasmapheresis
• How should spinal cord compression be treated in myeloma?


  As a radiotherapy emergency
• What factors influence specific treatment for myeloma?


  • Presence of poor prognostic factors
  • Comorbidities