Multiple myeloma
- Multiple myeloma is a malignant disease of plasma cells in bone marrow
- Accounts for 1% of all cancers
- 2,500 new cases each year in United Kingdom
- Most patients are over 60 years of age
- Characterised by production of monoclonal immunoglobulins
- These can be detected in serum, urine or both
Pathogenesis
- Monoclonal overgrowth of one clone of plasma cells occurs
- Produces monoclonal immunoglobulin or paraprotein
- In 80% patients an IgG or IgA is detectable in serum
- In 20% no paraprotein is detectable in the serum
- Free light chains may cross glomerulus and appear in urine
- These are known as Bence-Jones proteins
Clinical features
- Bone pain - especially back pain
- Pathological fracture
- Cord compression may occur
- Hypercalcaemia
- Renal failure
- Anaemia
- Immunosuppression
- Amyloidosis
Investigations
- Diagnosis confirmed by:
- Paraprotein in serum or urine on electrophoresis
- Lytic lesions on radiography
- Bone marrow aspirate with more than 10% plasma cells
Management
- 70% patients respond to therapy
- Complete remission is rare
- Median survival is 3 years
- Treatment options
- Melphalan chemotherapy
- Interferon-alpha
- Bone marrow transplantation
- Treatment of complications
- Dialysis for renal failure
- Bisphosphonates for hypercalcaemia
- Radiotherapy for localised bone pain
Bibliography
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