Multiple Myeloma Overview and Clinical Aspects

Multiple Myeloma

• Approximately 5,700 cases per year in the UK.
• Median age at diagnosis is 72.
• Cancer of plasma cells in the bone marrow that produce monoclonal immunoglobulins/proteins.
• Makes up approximately 1-2% of all cancers.
• Primarily affects older adults with the median age at diagnosis between 65-74 years old.

Multiple Myeloma: Clinical Manifestations

• Cancer of plasma cells leads to:
  • Bone infiltration:
    • Fractures, especially vertebral wedge fractures.
    • Hypercalcemia.
    • Pain
  • Renal damage.
  • Anemia.
  • Immunosuppression, leading to increased risk of infections.

Multiple Myeloma: Epidemiology

• About 10% of cases are associated with IgD, 50% with IgG, and 20-25% with IgA.

Multiple Myeloma: Pathophysiology

• Clinical manifestations are associated with the malignant behaviour of plasma cells and abnormalities produced by the M protein.
• Plasma cell proliferation:
  • Multiple osteolytic bone lesions.
  • Hypercalcemia
  • Bone marrow suppression (pancytopenia)
• Monoclonal M protein:
  • Decreased level of normal immunoglobulins
  • Hyperviscosity

Multiple Myeloma: Clinical Symptoms

• Bone pain, pathologic fractures.
• Weakness and fatigue.
• Susceptibility to serious infections.
• Renal failure.
• Bleeding.

Multiple Myeloma: Laboratory Tests

• Elevated Erythrocyte Sedimentation Rate (ESR) greater than 100.
• Anemia and thrombocytopenia.
• Rouleaux formation in peripheral blood smears.
• Marrow plasmacytosis exceeding 10-15%.
• Hyperproteinemia.
• Hypercalcemia.
• Proteinuria.
• Uremia.

Multiple Myeloma: Diagnostic Criteria

• Major Criteria*
• Plasmacytoma on tissue biopsy.
• Bone marrow plasma cell count greater than 30%.
• Monoclonal M spike on electrophoresis:
  • IgG greater than 3.5g/dl.
  • IgA greater than 2g/dl.
  • Light chain greater than 1g/dl in a 24-hour urine sample.
• Minor Criteria*
• Bone marrow plasma cells 10-30%.
• M spike present, but lower than the major criteria.
• Lytic bone lesions.

This quiz covers the key concepts of Multiple Myeloma, including its epidemiology, clinical manifestations, and pathophysiology. Learn about the characteristics of this plasma cell cancer and its effects on older adults. Perfect for healthcare students and professionals seeking to enhance their understanding of this disease.