Multiple myeloma – How is it diagnosed?
Multiple myeloma (MM) is a blood cancer involving plasma cells, located in the bone marrow.
The function of plasma cells is to produce immunoglobulins assisting with immunological protection. The malignant clone produces large quantities of an abnormal immunoglobulin referred to as an M protein. The disease course waxes and wanes overtime.
Despite advances in treatment, MM patients eventually experience a relapse of the disease.
Symptoms
The clinical manifestations include end organ dysfunction noted by high calcium levels, kidney failure, anaemia, unprovoked fractures, neurological manifestations, repeated infections, and bleeding.
MM may not cause overt symptoms in the early stages of the disease, however, as the disease develops, bone pain
has been noted in up to 70% of patients accompanied by other non-specific symptoms of fatigue, loss of appetite, constipation, and weight loss.
The initial presentation may commonly be to an orthopaedic surgeon with a fracture or bone pain, however, if MM is suspected a detailed BMAT to enumerate and identify the plasma cells. Flow cytometry for immunophenotypic confirmation and molecular analysis (FISH) for prognostication is advised.
The radiological analysis is paramount in demonstrating lytic lesions and/or fractures on either an MRI, low-dose whole body CT scan or a PET-CT scan.
Osteolytic lesions (osteoclastic lesions) are characterised by areas of damaged bone where myeloma cells release chemicals ensuing bone breakdown with the classic radiological appearance as a “punched-out” lesion commonly noted in the spine, skull, pelvis, and ribs.
Dr Jasmine Ramiah is a haematopathologist now pursuing super specialisation in clinical haematology at the Inkosi Albert Luthuli Hospital. She has a passion for transplant medicine, and management of haematolymphoid neoplasms.
Header image by Freepik
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