Welcome to the twenty sixth part of a series on Hemato-oncology.
Question: Dr. Chiragbhai, thank you for explaining the details ofMDS treatment options. What is the next disease we will be discussing?
Answer: Multiple myeloma – one of the most common hematological malignancies. It is also important and exciting as a number of new medicines and transplant have more than doubled survival in several cases. This is also a very important disease for practicing doctors especially physicians, orthopedic surgeons and pathologists, as it can be easily missed resulting in a serious outcome.
Que: What are the common presentations when our readers should consider Myeloma?
Ans: Presenting symptoms/signs/lab are nonspecific and can be easily missed. However following tips will help to ensure that such serious disease is diagnosed in time:
- Back pain – common symptom in practice. Test CBC, ESR, Creatinine for persistent pain more than 2-3 weeks, or earlier if pain is severe without obvious precipitating factor or associated with weakness in legs or xray showing osteopenia/osteoporosis type findings/lytic lesion. Anemia, high ESR, high creatinine should raise alarm and need for more work up. Do not just keep on changing pain killers with persistent pain.
- Anemia – another common finding. Consider myeloma if normal MCV, high ESR, rouelaux formation reported by pathologist, high creatinine, bone pain/back pain, normal iron studies or no response to iron/vitamin supplements. Always important to find out cause of any nonresponsive anemia over one month, even if pt is asymptomatic, as it could be other important causes as well.
- High creatinine – especially with anemia, high ESR.
- Compression fracture of Spine – without trauma, or xray showing osteopenia/osteoporosis.
- High protein with Globulin higher than Albumin
- High calcium
If any suspicion from above or other causes, at least order an SPEP (serum protein electrophoresis). This will pick up 80% of cases. If SPEP is normal and clinical suspicion is high, need hematologist intervention – for tests like bone marrow biopsy, free light chain assay and other tests.
It is important to remember that untreated myeloma can put patient at grave dangers, such as Renal Failure – irreversible if late; Paraplegia – due to spinal cord compression; Pathological bone fracture at various sites; serious infections due to reduced immunity.
Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 98243 12144, 98988 31496