Clinical Case Database / Category: Case Based Discussion
The spectrum of complications in myeloma
Dr Gordon Marron, Dr Jane Rutherford
Foundation Years Journal, volume 9, issue 3, p.67 (123Doc Education, London, March 2015)
Myeloma is a plasma cell neoplasm accounting for 10-15% of all haematological malignancies (1, 2). A disease of the elderly, the median age at presentation is 65 (1). Plasma cells are derived from B-lymphocytes whose usual role is to produce immunoglobulins (antibodies). In myeloma a genetic insult results in development of a malignant plasma cell clone in the bone marrow with impaired production of normal blood cells. Characteristically a monoclonal immunoglobulin known as a paraprotein is produced (1,2), which aids diagnosis and monitoring response to treatment. Sometimes only immunoglobulin light chains are produced. These are detectable in urine as Bence-Jones protein and blood as serum free light chains (3).
Myeloma is almost always preceded by a pre-malignant state called monoclonal gammopathy of unknown significance (MGUS), although this often goes unnoticed due to the absence of symptoms (3). The risk of progression from MGUS to myeloma is low at around 1% per annum. This article will focus on Ms J, a 56 year old lady, who presented with a very aggressive form of myeloma. Acute management of myeloma complications will be discussed with a particular emphasis on sepsis and renal failure.
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Dr Gordon Marron
Ward 34 Ninewells Hospital, Dundee, DD1 9SY
Dr Jane Rutherford (Corresponding author)
Foundation Year 1 Doctor,
Ward 34 Ninewells Hospital, Dundee, DD1 9SY
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3. British Committee for Standards in Haematology in conjunction with the UK Myeloma Forum (UKMF). Guidelines on the diagnosis and management of multiple myeloma. 2010.
4. Abcam. Guardian of the Genome p53 application guide. http://docs.abcam.com/pdf/cancer/p53-application-guide.pdf.
5. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K, et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med2003;348:1875-83.
6. Cavo M, Tacchetti P, Patriarca F, Petrucci MT, Pantani L, Galli M, et al. Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: a randomised phase 3 study.Lancet2010;376:2075-85.
7. Richardson PG, Weller E, Lonial S, Jakubowiak AJ, Jagannath S, Raje NS, et al. Lenalidomide, bortezomib, and dexamethasone combination therapy in patients with newly diagnosed multiple myeloma. Blood 2010;116:679-86.
8. Marik PE and Lipman J. The definition of septic shock: implications for treatment. Crit Care Resusc. 2007 Mar;9(1):101-3.
9. Wright H, Moots R ,Bucknall R, Edwards S. Neutrophil function in inflammation and inflammatory diseases. Rheumatology (2010) 49 (9):1618-1631.doi.
10. The Safer Use of Medicines Subcommittee of the Area Drug and Therapeutics Committee (ADTC). Sepsis is a medical emergency. Issue 11, February 2012.
11. Danckers M and Fried E. Arterial Blood Gas Sampling. Medscape. 2014.
12. NHS Scotland Assessment. Diagnosis and Management of Neutropenic Sepsis, Best Practice Statement. September 2011.
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