Introduction
Plasma cell myeloma (previously referred to as multiple myeloma), is cancer affecting the plasma cells in the bone marrow.
These abnormal plasma cells occur in increased numbers and produce abnormal non functional immunoglobulins leading to impaired ability to fight infections in the patient affected, hyperviscosity and renal failure.
In the bone marrow the increased plasma cells result in a reduction in normal blood cell production and erosion of bone with resultant peripheral blood cytopaenias, osteolytic lesions, pathological fractures and hypercalcaemia.
The disease is commonest in the sixth decade and rare below the age of 40 years.
Causes of plasma cell myeloma
The cause of plasma cell myeloma is unknown.
Potential precipitants of it include the following:
- Chemicals
- Examples: dioxins, formaldehyde, and nitrobenzene found in solvents and cleaning agents
- lonizing radiation
- Viruses
- Examples: Herpes Virus 8, Epstein-Barr, HIV, Hepatitis Virus
Symptoms of plasma cell myeloma
The symptoms include:
- Bone pain
- Easy fatiguability
- Excessive weakness
- Recurrent infections.
- Bony swellings
Signs of plasma cell myeloma
The following are the signs of the disease condition:
- Pallor Fever
- Dehydration
- Bony lumps
- Paraplegia
- Paresis
- Renal Impairment
- Unprovoked fractures
Investigations
- FBC and blood film comment
- ESR
- Blood urea, electrolytes, creatinine
- Plasma calcium levels
- Serum uric acid
- Bone marrow aspirate
- Skeletal survey including skull X-ray
- Serum protein levels
- Serum protein electrophoresis
- Urine Bence Jones protein
Treatment for plasma cell myeloma
Objectives
The treatment objectives of PCM include the following:
- To reduce the number of abnormal plasma cells to normal reduce their rate of increase
- To treat anaemia
- To reduce bone pain
- To manage pathological fracture
- To improve or maintain good bone mineral density
- To treat infections
- To prevent and treat renal complications
Non-pharmacological treatment
- Patients should drink at least 3 litres of fluid each day throughout the course of their disease
- Physiotherapy
- Orthopaedic supports
Pharmacological treatment
A. To reduce number of plasma cells and rate of increase
- Available at specialized centres only
B. To reduce bone pain
- Pain relief (avoid NSAIDS)
C. To treat anaemia
- Packed red cells transfusion and platelet transfusion when indicated
D. To prevent and treat renal complications
- IV and oral fluids
E. To mitigate tumour lysis
- Allopurinol to mitigate tumour lysis
F. To treat infections
Referral Criteria
All patients suspected to have plasma cell myeloma should be referred to a haematologist at a specialised tertiary centre for further evaluation and definitive management.
Subsequent follow-up can be done by a physician specialist with guidance from the haematologist.