Presentations
- Anaemia
- Bone lesions
- Bone pain
- Kidney failure
- Multiple myeloma CRAB symptoms (calcium elevation, renal insufficiency, anaemia and bone abnormalities), including hypercalcaemia
Conditions
- Monoclonal gammopathy of renal significance
- Monoclonal gammopathy of unknown significance
- Multiple myeloma
- Plasma cell leukaemia
- Smouldering myeloma
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Cardiomyopathy (diastolic dysfunction)
- Coagulopathy
- Cord compression
- Endocrinopathy
- Monoclonal gammopathy
- Organomegaly
- Peripheral and autonomic neuropathy
- Skin changes
Conditions
- Acquired secondary von Willebrand disease
- AL amyloidosis
- POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes)
- Solitary plasmacytoma
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Anatomy and physiology of the relevant aspects of the immune system
- Classification, molecular biology, and natural history of:
- AL amyloidosis
- myeloma
- other plasma cell dyscrasias
- Clinical manifestations, and current staging and prognostic systems
- Distinction between:
- monoclonal gammopathy of uncertain significance
- smouldering myeloma
- symptomatic myeloma
- Identification of plasma cell disorders using clinical and laboratory
criteria
- Normal anatomy and physiology, such as:
- cluster differentiation (CD) classification
- immunoglobulin assays
- lymphocyte molecular biology
- 'Normal' parameters and findings
Investigations
- Biochemistry
- Bone marrow biopsy
- Cytogenics, fluorescence in situ hybridisation (FISH), and single
nucleotide polymorphism (SNP) microarray and molecular assays
- Flow cytometry
- Full blood count and blood film morphology
- Histological assessment strategies for AL amyloidosis
- Imaging, such as skeletal survey technologies:
- CT
- MRI
- plain x-ray
- role of CT / PET
- Kidney function:
- cardiac markers, such as:
- serum:
- calcium
- electrophoresis
- free light chains
- urine
- Mass spectrometry – qualitative for amyloid diagnosis
- Monitoring of disease, including measurable residual disease
Procedures
- Bone marrow biopsy
- Lumbar puncture
- Disease and treatment-specific complications:
- implications for fertility
- infective complications of long-term immunosuppression
- long-term steroid use
- secondary cancers
- Drug-specific complications, such as lenalidomide and thrombosis risk
- Importance of collaborating with appropriate specialties in patient
management, such as radiation oncology and palliative care
- Management of acute and chronic specific complications, such as:
- bone disease
- hypercalcaemia
- hyperviscosity
- Management principles, such as:
- assessment of suitability for, and management of, high-dose therapy
- choice of specific chemotherapy regimes
- clinical trials
- formulation of an overall management plan for the initial presentation
- observation only
- place of radiotherapy
- Myeloma-specific palliative care and pain management
- Role of plasmapheresis:
- AL amyloidosis-specific therapy
- importance of considering drug combination order
- relapse monitoring
