Haem - multiple myeloma

Question 1

What is multiple myeloma

Answer 1

Neoplasia of plasma cells in BM

Question 2

wtf is paraprotein

Answer 2

monoclonal immunoglobulin

Usually IgG

Question 3

MM is more prevalent in whom?

Answer 3

Older age
Afro Carribeans
Farmers
Radiologists

Question 4

How do plasma cells –> myeloma?

Answer 4

Lots of DNA rearrangement during antibody production.

This can lead to translocations and Chromosomal deletions

If these affect TS genes/oncogenes –> myeloma

Question 5

Why does myeloma –> bone disease?

Answer 5

MM cells stimulate osteoclasts and inhibit osteoblasts –> osteolytic lesions

Question 6

What effect does myeloma have on the kidenys

Answer 6

PCT necrosis
Renal tubular acidosis
Cast nephropathy

Question 7

Features of multiple myeloma -name 5

Answer 7

Paraproteinaemia
Calcium - high
Renal failure
Anaemia
Bone - pain, osteolytic lesions

Question 8

1 very important Ix for suspected multiple myeloma and the +ve result?

Answer 8

Serum electrophoresis

One dense narrow band

Question 9

Which inflammatory marker is raised in MM?

Answer 9

ESR

Question 10

Which Ix is important for investigating bone lesions in MM?

Answer 10

CT

Question 11

Urine results in MM

Answer 11

Bence Jones proteins

Question 12

Premalignant form of MM? how does it differ from MM?

Answer 12

MGUS

Bone marrow is <10% clonal plasma cells with no CRAB Sx.

Question 13

Why are multiple Tx needed for MM?

Answer 13

Clone cells undergo proliferation but these compete with each other. Different sub clones respond to diff treatments

Question 14

3 forms of treatment for MM

Answer 14

Auto-SCT
steroids
proteasome inhibitors

Question 15

How does autoSCT work

Answer 15

Take blood from patient
Treat with mephalan - to kill MM cells
Reinfuse with treated blood

Question 16

Bortezomib - drug class?

Answer 16

proteasome inhibitor

Question 17

How do proteasome inhibitors work to treat MM?

Answer 17

Prevents ER associated degradation of misfolded proteins

Misfolded proteins therefore accumulate in the cell –> ER stress and a.a. starvation –> cell death

Question 18

how does thalidomide work

Answer 18

disrupts a transcription factor complex –>disrupts proteasome function –> kills MM cells

Question 19

number 1 most common Sx in MM patients?

Answer 19

back pain