Multiple Myeloma

Multiple Myeloma is a malignant tumor of plasma cell. Plasma cell produce poly-clonal immunoglobulin. But plasma cell tumor is monoclonal. In Multiple Myeloma they can produce pure immunoglobulin or only heavy chain or only light chain.

Clinical Feature:
Diagnosis of MM requires two of the following criteria

1. Increased malignant plasma cells in the bone marrow
2. Serum and/or urinary paraprotein
3. Skeletal lytic lesions.

Other features and investigation of MM:

• Generalized bony pain
• Recurrent infection
• Severe anemia with features of anemia
• Hypercalcemia
• Pathological calcification
• Features of hypercalcemia
• Retinal bleeds
• Bruising
• Heart failure
• Cerebral ischaemia
• Pancytipenia
• Raised ESR.

Plasma alkaline phosphatase and isotope bone scan will be normal despite the lytic action because there is no osteoblastic activity.

Management:

1. If patients are asymptomatic treatment may not be required.
2. Immediate support

• High fluid intake to treat renal impairement
• Analgesia for bone pain
• Biphosphonates for hypercalcaemia and to delay other skeletal related events
• Allopurinol to prevent urate nephropathy
• Plasmapheresis for hyperviscosity

1. Chemotherapy: Thalidomide
2. Bone marrow transplantation

Adverse effect of Thalidomide: Somnolence, Constipation, Peripheral neuropathy, Teratogenic effect.

Prognosis:
Low prognostic features include 

• High Microglobulin
• Low albumin
• Low Haemoglobin
• High calcium;  at presentation.

Median life expectancy: 2 Years.

• Absence of monoclonal band in plasma electrophoresis exclude MM.
• Amyloidosis is Only light chain producer.
• Another cause of very high ESR is Temporal arteritis.