Know the important facts about multiple myeloma

Explanation:

The scenario can be usually intermingled with loads of non-specific complaints.

When I took the boards, there was a patient with nonspecific backache &, fatigue,  who was elderly. His Hemoglobin was low.
This information was described over half a page- so guess what - It now makes such an obvious diagnosis extremely difficult to make out.

Diagnosis is confirmed by two out of 3 criteria to be fulfilled.

1. Serum electrophoresis with M band/Urine bence-jones protein
2. Lytic bone lesions
3. Abnormal bone marrow consistent with myeloma

Patients are affected with frequent infections especially UTIs. They should receive vaccines against Pneumococci, H.influenzae & N.meningitidis. The Flu shot too should be administered seasonally (Nov-Mar)

Prognosis is worsened with the presence of Anemia, Renal dysfunction, Anemia, Hypercalcemia and elevated beta-2 microglobulin levels.

Treatment utilizes - Chemo - based on Melphalan
Young patients may benefit from bone marrow transplant
Pamidronate is helpful in preventing bone lesions and bone pain
Radiation is used to help with local symptoms of Plasmacytomas

References
Bisphosphonates in multiple myeloma.
Berenson JR
Cancer. 1997 Oct 15;80:1661­7: Issue: 8 Suppl

The use of bone marrow and peripheral blood stem cell transplantation in the treatment of cancer
Appelbaum FR
A Cancer Journal For Clinicians. 1996 May­Jun;46:142­64: Issue: 3