Myeloma
- B-cell lymphoid malignancy
- Clonal proliferation of plasma cells (synthesize abnormal Ig)in bone marrow
- Commonest primary malig. tumour of bone (1% of bone Tu)
- No specific risk factors
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)
Note : MRI useful for vertebral lesions, Chromosomal abnormalities may help with prognosis. ESR may be normal (non-Ig producing myeloma).
Treatment
- Stage the condition (based on B marrow, proteinuria load on electrophoresis etc.)
- Confirm renal status, chromosomal abnormalities and Plasma cell labelling index (PCLI)
- Aim to control disease and manage symptoms (beware electrolytes, Ca
++ - Aggressive appropriate analgesia as required
- Options include chemoRx, radioRxs, immunomodulation and marrow transplant
