A Case of Multiple Myeloma

Dr Noor-E-Jabeen, Dr Afrin Haque, Dr Zahid Mahmud

Multiple myeloma is the malignant proliferation of the plasma cells. The median age of diagnosis is 60 to 70 years and male to female ratio is 2:1. Most important clinical features with which most of the patients present, are features of anaemia, bone pain, features of spinal cord compression and renal failure. Diagnosis is confirmed by increased malignant plasma cell in the bone marrow, serum /urinary M protein and skeletal lytic lesions. If two of these criteria are present then diagnosis is confirmed. Management protocol depends on whether patient is symptomatic or not. The treatment includes chemotherapy with or without Haematopoietic Stem Cell Transplant (HSCT), Radiotherapy and / or bisphosphonates. With the advancement of drug therapy, early diagnosis and initiation of treatment, over one third of the patients are now surviving for 5 years or more.

Case history

A 47 year old hypertensive lady was admitted in United Hospital with the complaints of fever for 5 days, generalized body ache for 1 month and weakness with occasional exertional dyspnoea for same duration. According to the statement of the patient she was reasonably well 1 month back. Then she developed generalized weakness, fatigue and occasional exertional dyspnoea and on query she gave history of spontaneous nasal bleeding for 3 episodes in the last 1 month. She was also having low grade fever which was not documented at home. Her bowel and bladder habit was normal and there was no history of cough, abdominal pain, joint pain, rashes or oral ulceration.

On examination, she was found to have severe anaemia, tenderness all over the body, more marked on the right lateral chest, no thyromegaly and no lymphadenopathy. BP was 140/90 mm of Hg and pulse was 84/min. All other systems revealed no abnormality.

After admission, her Hb was 5.6 gm/dl and platelet count was 89200/cumm. Her peripheral blood film (PBF) revealed leuco-erythroblastic blood picture with thrombocytopenia. Serum albumin was 28 gm /l and S. calcium was 2.06 mmol/L. S. protein electrophoresis was done and revealed monoclonal (M band) band in gamma region with hypoalbuminaemia. Urinary Bence-Jones protein was positive, β-2 microglobulin was 3.83 mg/L, S. IgG was 7318 mg/dl. All other biochemical parameters were normal. Bone marrow examination revealed plasma cell disorder probably Multiple Myeloma. So this middle aged lady after thorough examination and investigation was labeled as a case of multiple myeloma. After admission she received 4 units of packed red cell. After confirmation of her diagnosis and proper counseling with patient’s attendant regarding her diagnosis and treatment outcome, conservative drug therapy was started with inj. Bortezomib (2mg), cap. Thalidomide (100mg), tablet Dexamethasone (4mg). Then the patient was discharged and she is now getting regular treatment as an out-patient case.