Multiple Myeloma
All of the following are features of multiple myeloma, except:
Multiple Myeloma
- The most common variant. Approximately 20,000 new cases per year in the United States. Median age at diagnosis is 70 years; more common in males and in people of African origin. Principally involves bone marrow with lytic lesions throughout
- Free light chains only (κ or λ) — 15–20%; excreted in urine as Bence Jones proteins
- Most malignant plasma cells secrete both complete immunoglobulins and free light chains → both M proteins and Bence Jones proteins
- Chromosomal translocations involving the IgH locus (chromosome 14) and various partners including cyclin D1, FGFR3, and cyclin D3 → dysregulation of D cyclins is common
- Late in course, MYC translocations may also occur
Read this in White Cell Disorders — Must-Know Notes
What our notes say
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Practice questions on Multiple Myeloma
Multiple myeloma is diagnosed by the presence of all of the following EXCEPT
- Clonal plasma cells >10% in bone marrow
- Monoclonal protein in serum/urine
- Reed-Sternberg cells
- CRAB criteria (calcium, renal, anaemia, bone)
Answer: C. Reed-Sternberg cells are seen in Hodgkin lymphoma, not myeloma. Myeloma diagnosis requires plasma cell proliferation with end-organ damage. ---
Which analyte is most useful in the diagnosis of multiple myeloma?
- Serum iron
- Beta-2 microglobulin
- Serum protein electrophoresis
- Alkaline phosphatase Correct
Answer: C. SPEP detects monoclonal proteins (M-proteins) characteristic of multiple myeloma, showing abnormal immunoglobulin bands. ## Section 2: Endocrine Disorders & Hormone Assays ---
A 65-year-old woman with multiple myeloma has total calcium of 7.5 mg/dL and albumin of 2.5 g/dL. What is her corrected calcium level? (Use: Corrected Ca = Measured Ca + 0.8 × (4 - Albumin))
- 8.2 mg/dL
- 7.5 mg/dL
- 9.0 mg/dL
- 10.0 mg/dL Correct
Answer: A. Corrected Ca = 7.5 + 0.8 × (4 - 2.5) = 7.5 + 1.2 = 8.7 ≈ 8.2 mg/dL. Corrects for low albumin. ---
Which of the following is a common clinical finding in multiple myeloma?
- Splenomegaly
- Lymphadenopathy
- Petechiae
- Lytic bone lesions
Answer: D. Osteoclast-activating factors from myeloma cells cause characteristic punched-out lytic lesions, unlike lymphomas/leukaemias which more often cause organomegaly. ---
Which of the following features distinguishes monoclonal gammopathy of undetermined significance (MGUS) from multiple myeloma?
- Presence of lytic lesions
- Presence of anaemia
- Elevated M protein without end-organ damage
- Hypercalcaemia
Answer: C. MGUS is defined by a monoclonal protein below myeloma-defining levels with no CRAB (calcium, renal, anaemia, bone) end-organ damage. ---