Multiple Myeloma

Multiple Myeloma in MRCP

Multiple Myeloma (MM) is a very important disease in haematology, MRCP. It is frequently asked and there are various clinical presentations in MM. Candidates must know that the malignant cells ( proliferation of plasma cells) are from bone marrow and not cortex of the bone ( as compared to osteosarcoma or scondary deposits of distant tumour to boen cortex). The monoclonal plasma cell line produces immunoglobulin which is abnormal and leads to suppression of normal immunity.

Clinical Presentations

Remember this mnemonic CRAB
Calcium abnormality - increased calcium level due to enhanced osteoclastic activity. Patients can present with confusion, dehydration, polyuria or even abdominal pain.
Renal impairment. Patients can present with tiredness
Anaemia ( due to suppression of bone marrow)- symptoms of anaemia
Bony abnormality- lytic lesions in almost 60-70%- bony pain

Physical Signs

Usually no hepatosplenomegaly but you may notice pallor, dehydration or bony tenderness.

Investigations

Monoclonal gammopathy ( usually Ig G- as compared to Waldenstrom's Macroglubinaemia which has increased Ig M)
Bone Marrow shows more than 30% plasma cells
Skeletal survey shows mutiple osteolytic lesions ( Candidates must remember that ALP of patients may be normal except there is presence of bone fracture)
ESR usually very high

Treatment

Thalidomide- Remember this drug in your medical student books? Thsi drug was usd extensively many years ago for insomnia and morning sickness for pregnant mothers but it was later found to be teratogenic. ( Remember your medical books with photo of babies without upper and lower limbs?)
However, current trials show it effectiveness against MM. Click here to learn more!

The latest drug- bortezomib!

Tips for MRCP
1) Suspect MM if patient has anaemia, renal impairment, high ESR and Calcium level.