Plasma Cell Myeloma

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 isĀ  unknown.
Potential precipitants of it include the following:

  1. Chemicals
    • Examples: dioxins, formaldehyde, and nitrobenzene found in solvents and cleaning agents
  2. lonizing radiation
  3. Viruses
    • Examples: Herpes Virus 8, Epstein-Barr, HIV, Hepatitis Virus

Symptoms of plasma cell myeloma

The symptoms include:

  1. Bone pain
  2. Easy fatiguability
  3. Excessive weakness
  4. Recurrent infections.
  5. Bony swellings

Signs of plasma cell myeloma

The following are the signs of the disease condition:

  1. Pallor Fever
  2. Dehydration
  3. Bony lumps
  4. Paraplegia
  5. Paresis
  6. Renal Impairment
  7. 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:

  1. To reduce the number of abnormal plasma cells to normal reduce their rate of increase
  2. To treat anaemia
  3. To reduce bone pain
  4. To manage pathological fracture
  5. To improve or maintain good bone mineral density
  6. To treat infections
  7. 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.