EMed

Myeloma

Background

  • B-cell lymphoid malignancy
  • Clonal proliferation of plasma cells (synthesize abN Ig) in marrow
  • Commonest primary malignant tumour of bone (1% of bone Tu)
  • No specific risk factors
SXR Pepper pot of Myeloma

Clinical

  • May present as incidental finding (e.g. x-ray, ↑ESR, ↑Ca++) or very aggressive painful bony destruction
  • Often background history of renal symptoms or vague constitutional symptoms (anaemia)
  • Rarely recurrent infections : hypogammaglobulinaemia

Major criteria

  • Monoclonal protein on electrophoresis or Bence Jones proteinuria >1 g/24 hr
  • Bone marrow plasma cells at least > 10%
  • Lytic bony lesions

Minor criteria

  • Cytopenia (esp. ↓Hb or ↓Platelets)
  • Renal failure and hypercalcaemia
  • Hyperviscosity (SOB, confusion, chest pain)

Investigations

  • MRI useful for vertebral lesions
  • Chromosomal abnormalities may help with prognosis
  • ESR may be normal (non-Ig producing myeloma)

Treatment

  1. Stage the condition (based on B marrow, proteinuria load on electrophoresis etc.)
  2. Confirm renal status, chromosomal abnormalities and Plasma Cell Labelling Index (PCLI)
  3. Aim to control disease and manage symptoms (beware electrolytes, ↑Ca++, renal fxn and cytopaenias)
  4. Aggressive appropriate analgesia as required
  5. Options include chemoRx, radioRxs, immunomodulation and marrow transplant

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 12/04/23.