Multiple Myeloma (MM)

Exam Cram

• Multiple myeloma is a Plasma cell dyscrasia 

• Presentation (CRAB): hypercalcaemia, renal failure, anaemia, boney pain

• Diagnosis: bone marrow aspirate, raised serum free light chains or > 1 boney lesion on MRI

• Management: CHOP regime (thalidomide + cyclophosphamide + pred) & blood transfusions,  bone marrow transplant

OUtline

Presentation

History

• 60yrs, subacute presentation

• Constipation, tiredness, reduced exercise tolerance

• Low trauma fracture or back pain

Examination

• Spinal tenderness

Investigations

• AKI

• Anaemia

• Hypercalcaemia

• Raised blood protein electrophoresis

• Raised urinary bence jones proteins

• Imaging (XR, CT, MRI): osteoblastic lesions

Diagnosis

Screening test: raised protein electrophoresis or bence jones proteins

Diagnostic criteria: IMWG Criteria- 2014 > 0

• Bone marrow aspirate: > 60% clonal plasma cells

• Raised serum free light chains (kappa or lambda)

• MRI: > 1 focal lesion that is > 5mm

Differentials: malignancy of unknown cause

Management

• R-CHOP chemotherapy

• Bone marrow stem cell transplants

• RBC transfusions

• Local radiotherapy

Med Reg Notes

Management

Induction of remission therapy: R-CHOP if good functional status / under 65yrs prior to bone marrow transplant

MGUS (Monoclonal Gammopathy of Uncertain Significance)

Definition

• Paraprotein < 30 g/l

• Bone marrow: plasma cells < 10%

• Nil end organ damage: renal, skeletal, bone marrow impairment

Prognosis: 1% annual progression to myeloma. 

References and Resources

1. https://www.myeloma.org/international-myeloma-working-group-imwg-criteria-diagnosis-multiple-myeloma

2024