Abstract
Myeloma is a malignancy of plasma cells which are terminally differentiated B-lymphocytes. The diagnosis may be made incidentally at routine blood testing, when an abnormality is found in the plasma proteins on electrophoresis. More usually the patients are symptomatic, with bone pain, anaemia, evidence of renal failure, or the metabolic abnormalities associated with increased plasma calcium and urate levels. Effective treatment will extend survival from 7 to approximately 30 months and at the same time improve the quality of life. Treatment is multidisciplinary, prominently involves the professional nurse and may arbitrarily be divided into two stages. Firstly, reversible lesions, such as dehydration and plasma hyperviscosity must be corrected, hypercalcaemia and hyperuricaemia improved and, if necessary, renal dialysis undertaken. Secondly, but of equal importance, is the need for specific therapy to be directed against the tumour itself, and both cytotoxic agents and irradiation have an important role to play. More recently, newer approaches have included high dose chemotherapy and bone marrow transplantation.
Highlights
FUTURE RESEARCH INDICATORSIN TRODUCT IO N Many of the clinical features and biochemical abnormalities of myeloma were described more than 100 years ago, and in the late stages of the disease there should be little difficulty in making the diagnosis
Myeloma is a malignancy o f plasma cells which are terminally differentiated B-lymphocytes
More usually the patients are symptomatic, with bone pain, anaemia, evidence o f renalfailure, or the metabolic abnormalities associated with increased plasma calcium and urate levels
Summary
IN TRODUCT IO N Many of the clinical features and biochemical abnormalities of myeloma were described more than 100 years ago, and in the late stages of the disease there should be little difficulty in making the diagnosis. A num ber of cases are still missed because many individual practitioners have limited experience, having seen few examples during their careers or through not maintaining a sufficiently high index of clinical suspicion to recognise the telltale findings. This deficiency is transmitted to nursing and paramedical professionals since less attention is paid in their training to the diagnosis of this disease and the role of these colleagues in management is significantly under-utilised. To bring perspective to current management and to emphasize the role of the professional nurse, the more important clinical and laboratory features are briefly reviewed
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