Multiple myeloma is a cancer of plasma cells that results in overproduction of a single type of antibody known as a paraprotein. It most commonly affects people over age 70 and symptoms include back pain from lytic bone lesions, anemia, infections, and kidney problems. Diagnosis involves blood and urine tests detecting the paraprotein and plasma cell percentage in bone marrow. Treatment involves supportive care as well as chemotherapy, with median survival of 3-4 years.

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2.  Malignant clonal proliferation of b-lymphocyte plasma
cells
 Normal: different plasma cells produce different
Immunoglobulin w/c are polyclonal
 Myeloma: single clone of plasma cell produce identical
Immunoglobulin- seen as monoclonal band or
paraprotein

3.  incidence: 5/100,000
 Peak: 70 years old

4. Symptoms
 Do serum protein electrophoresis & ESR on ALL >50yo
with BACKPAIN
 Osteolytic bone lesions- backache, pathological fx &
vertebral collapse
 Anemia, neutropenia & thrombocytopenia- results
from marrow infiltration by plasma cells

5. Symptoms
 Recurrent bacterial infections: due to immunoparesis
and neutropenia
 Renal impairment due to light chain deposition
precipitation of,light chains with the TammHorsfall
protein in the distal loop of henle
 Monoclonal Ig induce changes in the glomeruli

6. test
 CBC: NCNC anemia
 PBF: Rouleaux formation
 high ESR
 High Urea & Crea
 High Ca
 Normal ALP

7.  Screening Test: serum & urine electrophoresis
 B2 microglobulin: as a prognostic test
 XRAY: punch-out lytic lesions

8. Myeloma Diagnostic Criteria
 Monoclonal protein band in serum/urine
electrophoresis
 Increase plasma cell in BMA biopsy
 Evidence of end organ damage from MYELOMA:
1. Hypercalcemia
2. Renal insufficiency
3. anemia

9. treatment
 Supportive:
 Bonepain: analgesia, avoid NSAIDs
 Bisphosphonates: to tx hypercalcemia acutely
 Anemia: should be corrected with transfusion &
Erythropeitin
 Renal failure: rehydrate, ensure 3L/day
 Infections: broadspectrum ABX until C/S is out

10.  Chemotx: if unsuitable for intensive tx
 Melphalan + Prednisone

11. prognosis
 Median survival: 3-4years
 High b2- microglobulin worse prognosis
 Death infection/ renal failure

12. complications
 Hypercalcemia - rehydrate 4-6liter/day
- IV Bisphosphonate
 Hyperviscosity-reduced cognition, bleeding, disturbed
vision
 Spinal cord compression – Urgent MRI if suspected
- txt: Dexamethasone 8 - 16mg/24hrs