Myeloma

Question 1

In myeloma what type of cell proliferates to cause malignancy?

Answer 1

plasma cell

Question 2

Median age of presentation

Answer 2

70

Question 3

What are the main symptoms of myeloma

Answer 3

Calcium - hypercalcaemia

Renal impairment - light chain deposition in tubules

Anaemia - crowded bone marrow suppresses production

Bleeding

Bones - lytic lesions

Infection - producing abnormal Ig => more susceptible

Question 4

Other features of myeloma

Answer 4

amyloidosis e.g. macroglossia
carpal tunnel syndrome
neuropathy
hyperviscosity

Question 5

What causes hypercalcaemia in myeloma?

Answer 5

• increased osteoclastic bone resorption caused by local cytokines (e.g. IL-1, tumour necrosis factor) released by the myeloma cells
• less common:
  impaired renal function, increased renal tubular calcium reabsorption and elevated PTH-rP levels

Question 6

Other causes of impaired renal function in myeloma

Answer 6

• amyloidosis
• nephrocalcinosis
  -nephrolithiasis

Question 7

Characteristic finding on peripheral blood film

Answer 7

Roleaux formation
(stacked like coins)

Question 8

Specific tests used to look for myeloma

Answer 8

Serum protein electrophoresis
=> raised concentrations of IgA/IgG

Bence Jones Proteins in urine

Question 9

Typical finding on bone marrow

Answer 9

Increased number of plasma cells

Question 10

Major and Minor criteria for myeloma diagnosis

Answer 10

Major criteria
- Plasmacytoma
- 30% plasma cells in a bone marrow sample
- Elevated levels of protein in the blood or urine

Minor criteria
- 10% to 30% plasma cells in a bone marrow sample.
- Minor elevations in level of protein in the blood or urine.
- Osteolytic lesions

Question 11

Indicators of poor prognosis in myeloma

Answer 11

Raised B2 microglobulin
Low albumin