Multiple myeloma

Multiple myeloma is characterized by neoplastic proliferation of a plasma cell line that produces monoclonal immunoglobulin.

 

Presents with @CRAB features (i.e. hyperCalcemia, acute Renal failure, Anemia and Bone lytic lesions).

 

Clinical features are:-

1. Bone pain / Bone lytic lesions due to increased osteoclast activity.

2. Fatigue due to anemia.

3. Increased susceptibility to infection.

4. Weight loss.

5. Amyloidosis.

 

Diagnosis:-

1. CBC shows normocytic normochromic anemia.

2. Deranged RFT (i.e. elevated BUN and creatinine), Serum calcium is elevated; LDH is elevated; Serum uric acid is elevated; ESR is elevated (Therefore, causes rouleaux formation).

3. Serum protein electrophoresis shows “M spike”.

4. Urine protein electrophoresis shows Bence jones protein (Urine dipstick is negative in multiple myeloma, as it mainly detects albumin but not Bence jones protein).

5. Serum beta 2 microglobulin (increased levels of serum beta 2 microglobulin in patients with

multiple myeloma have been associated with a poor prognosis).

6. Bone marrow biopsy shows > 10 % abnormal plasma cells.

7. X ray shows lytic bone lesions.

8. MRI shows detailed images of bone marrow infiltration.

 

Management:-

1. Chemotherapy includes bortezomib (V), dexamethasone (D), lenalidomide(R),

cyclophosphamide (Cy); (i.e. The most common regimens are RD, VD, RVD, VCyD).

2. Allogeneic hematopoietic stem cell transplantation.