25. multiple myeloma

Question 1

what is the criteria for MM diagnosis?

Answer 1

1) M-protein in serum (>30g/L) and/or urine
2) Bone marrow clonal plasma cells >10% OR plasmacytoma
3) myeloma-related organ or tissue impairment (ROTI):
* lytic bone lesions
* Ca2+ >1.5 g/L
* creatinine > 2mg/dL
* Hgb <10 g/dL

Question 2

what tests are used to diagnose MM?

Answer 2

1. SPEP–> +in 80% of patients
2. UPEP–> detects light chains (Bence jones proteins), + in 20% of patients
3. immunofixations- lambda/kappa
4. serum-free light chain assay- important for diagnosis and follow up

Question 3

treatment of plasmacytoma (solitary or extramedullary)

Answer 3

local radiation therapy

Question 4

treatment of MM (transplant eligible <70 y’)

Answer 4

high dose chemo–> autologous HSCT –> maintenance therapy

chemo: VTD regimen- bortezomib, thalidomide, dexamethasone
maintenance: lenalidomide

Question 5

treatment of MM ( not transplant eligible > 70 y’, systemic comorbidities)

Answer 5

systemic chemo –> melphalan +prednisone +thalidomide/ lenalidomide
if high risk–> proteasome inhibitor (bortezomib)

Question 6

treatment for relapsing/refractory MM

Answer 6

chemo (lenalidomide + dexamethasone)

Question 7

what is ‘POEMS syndrome’?

Answer 7

neurologic manifestation in MM

polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes

Question 8

what is smoldering myeloma?

Answer 8

M-protein > 30g/L
marrow plasmacytosis >10%
but asymptomatic and no ROTI

Question 9

What is MGUS?

Answer 9

Monoclonal gammopathy of undetermined significance
M-protein < 30g/L
marrow plasmacytosis < 10%
no bence proteins no ROTI

can develop into MM, WM, amyloidosis

Question 10

what is Waldenstrom macroglobulinemia?

Answer 10

B-cell neoplasm that secrets IgM

seen with hyperviscosity syndrome but no bone lesions