Haematology 11 - Plasma cell myeloma and Monoclonal Gammopathy of Uncertain Significance Flashcards
What immunoglobin is produced by myeloma cells?
One single type (eith IgG or IgA) which is known as paraprotein or M spike
What are Bence Jones proteins?
Urine monoclonal free light chains
What is Waldenstrom’s-Lymphoplacytic lymphoma?
A lymphoplasmocytic lymphoma with IgM paraprotein that causes visual disturbances
What is the name of the premalignant condition that always precedes myeloma?
Monoclonal gammaopathy of uncertain significance (MGUS)
What are the two most significant risk factors for myeloma?
Obesity
Black > causasians/ asians
What are the diagnostic criteria for MGUS?
Serum M-protein <30g/L
BM clonal plasma cells <10%
Asymptomatic
What is smouldering myeloma?
Serum M-protein >30g/L
BM clonal plasma cells >10%
Asymptomatic
What % of plasma cells is there in symptomatic multiple myeloma?
> 10%
What is the most notable interaction of myeloma cells with the bone marrow micro-environment?
Produce RANK ligand which stimulates osteoclasts to cause bone resorptions
What is the incidence of IgM myeloma?
Very rare (<1% of myelomas)
What does CRAB stand for in myeloma diagnosis?
Calcium (hypercalcaemia, >2.75)
Renal (creatinine >177/ eGFR <40)
Anaemia
Bone disease (see lytic lesions)
What is the most common and 2nd most common cytogenetic abnormality in myeloma?
- Hyperdiploid karyotype
2. IgH gene rearrangement
What are the 3 2014 Myeloma Defining Events
BM plasma cells >60%
involved:uninvolved FLC ratio >100
>1 focal lesion on MRI
Which part of the skeleton is affected by myeloma?
Proximal skeleton (spine, skull, knees)
Where are myeloma patients most likely to feel pain?
Back, chest wall, pelvis
What % of myeloma patients present with bone disease?
80%