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Myeloma (Treatment (Chemotherapy (CTD - CYCLOPHOSPHAMIDE, THALIDOMIDE and…
Myeloma
Treatment
Rehydrate and ensure adequate fluid intake of 3L/day to prevent further renal damage e.g. by immunoglobulin light chains
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Bone pain supported with analgesia, avoid NSAIDs due to risk of renal impairment
Chemotherapy
CTD - CYCLOPHOSPHAMIDE, THALIDOMIDE and DEXAMETHSONE - max 8 cycles - for less fit people
VAD - VINCRISTINE, ADRIANMYCIN and DEXAMETHASONE in fitter people - max 6 cycles
Pathology
Normal plasma cells produce a wide range of immunoglobulins (antibodies) such as IgG, IgA, IgM & IgD
However, in myeloma the malignant plasma cells just produce an EXCESS of one type of immunoglobulin - monoclonal paraprotein
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The accumulation of malignant plasma cells in the bone marrow leads to progressive bone marrow failure
Other immunoglobulin levels are low resulting in immunoparesis resulting in increased susceptibility to infections
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Leads to bone disease, hypercalcaemia and renal failure
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Clinical Presentation
OLD CRAB
Renal failure - nephrotic syndrome, since due to raised immunoglobulins which are proteins which precipitate (especially immunoglobulin light chains) and deposit in organs ESPECIALLY the kidneys - results in THIRST due to lack of water retention
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