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Myeloma MSCC — RACP Adult Medicine MCQ

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ModerateHaematologyMyeloma MSCCRACP Adult Medicine

A 55-year-old man with recently diagnosed multiple myeloma develops acute back pain and bilateral leg weakness with urinary retention. MRI shows epidural plasmacytoma causing spinal cord compression at T8. What is the priority treatment sequence?

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Correct answer: E — Dexamethasone stat → urgent radiation therapy → systemic myeloma treatment

In myeloma-related MSCC, the priority sequence is: (1) High-dose dexamethasone 16–40 mg IV stat (reduces oedema and has direct anti-myeloma effect), (2) Urgent radiation therapy (myeloma is radiosensitive – the majority of cases are treated with RT rather than surgery), (3) Systemic myeloma treatment (chemotherapy ± autologous SCT for eligible patients). Surgery is considered for spinal instability, radioresistant disease, or uncertain diagnosis. Dexamethasone in myeloma serves a dual role – it is both a component of cancer treatment and an anti-oedema agent for cord compression.

Reference: eTG – 2025 – Haematology; NICE – 2023 – MSCC Guidelines