Multiple Myeloma
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Introduction
Multiple myeloma is an aggressive malignancy. It is the most common hematological neoplasm in black people, and the second-most common in white people.
The median age at diagnosisis is 70. Men are more commonly affected.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Pathophysiology
MM is a malignancy that begins in the bone marrow, with transformation of plasma cells.
Normally, a single clone of cells proliferate, with a monoclonal immunoglobulin produced.
Signs and Symptoms
- history
- physical exam
History
tumour effects:
- bone pain or fractures
- hypercalcemia
- marrow failure
- anemia: fatigue, shortness of breath, pallow
paraprotein effects:
- renal failure
- immunosuppression
- hyperviscosity
- amyloidosis
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Complete blood count
- anemia
- thrombocytopenia
- neutropenia
Electrolytes
- increased creatinine
- hypercalecemia
Protein electrophoresis
- paraprotein in the blood
- Bence-Jones protein in the urine
- hypoimmunoglobulins
- monoclonal protein spike
Bone marrow
- malignant plasma cells: bizarre, immature cells
Peripheral smear
- rouleaux (stacked chains) of RBC
Diagnostic Imaging
bone scans insensitive. plain films may be sueful; MRI is very sensitive
Differential Diagnosis
Treatments
Supportive care:
- pain control
- bisphosphonates to prevent skeletal events
Melphalan and prednisone
Bone marrow transplant may be considered if the patient is young and healthy
Consequences and Course
The consequences of MM are many.
Calcemia causes constipation, polyuria and polydypsia. Renal failure can also occur.
Anemia can be serious.
Renal failure can follow hypercalcemia and uremia.
Lytic bone lesions can occur following destruction by tumour cells.
Prognosis is unfortunately quite poor.
- natural history: less than 18 months
- standard therapy: 36 months
- autologous BMT: 60+ months
Resources and References
Topic Development
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