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Chapter 21 Multiple myeloma and related disorders / 287

■ In patients younger than 70 years, ■ Amyloidoses are caused by extracellular
myeloma is usually treated by intensive deposition of protein in an abnormal
chemotherapy followed by an autologous fi brillar form. Systemic AL amyloid disease
stem cell transplant using stem cells is caused by monoclonal light chains
harvested from the patient. produced from a clonal plasma cell

■ In older patients chemotherapy alone is proliferation and may cause heart failure,
used. However, in both age groups the macroglossia, peripheral neuropathy or
disease is virtually never cured. New drugs renal failure.

such as thalidomide, bortezomib and ■ Hyperviscosity syndrome may occur in
lenalidomide are improving the outlook for paraproteinaemia or in patients with very
patients and average survival is now 4 – 5 high red or white cell counts. Clinical
years. features include visual disturbances,

■ A plasmacytoma is a localized mass of confusion and heart failure. Venesection,
malignant plasma cells and is usually plasma exchange or chemotherapy may
treated with radiotherapy. Many cases be required.
progress to myeloma.
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