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Multiple myeloma — RCPSC IM MCQ

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HardHematologyMultiple myelomaRCPSC IM

A patient with IgG myeloma has creatinine 310 µmol/L, anemia and a rapidly rising involved free-light-chain concentration. Hypercalcemia and obstruction are excluded. What is the management priority?

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Correct answer: BTreat the myeloma urgently while correcting volume depletion

The best answer is “Treat the myeloma urgently while correcting volume depletion”. Suspected cast nephropathy is a time-critical myeloma emergency. Rapid reduction of light-chain production and supportive kidney protection improve renal recovery; delay, additional hemodynamic stress and forced diuresis can worsen tubular injury. Rapid reduction of the pathogenic light-chain burden is time critical because prolonged tubular exposure can make kidney injury irreversible; supportive care alone cannot control ongoing production.

Reference: Cancer Care Ontario, myeloma guidelines and advice: https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/hematologic/myeloma