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IHO Final- Krafts > Krafts- Myeloma > Flashcards

Krafts- Myeloma Flashcards

1
Q

What are things you must know about multiple myeloma?

A

Monoclonal plasma cell proliferation
Monoclonal gammopathy (everything is the same but there is an increase in Igs)
Decreased normal Igs
Osteolytic lesions

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2
Q

What lab findings are associated w/ multiple myeloma?

A

M spike
Type of IgG (might make whole things or just heavy chain or light chain)
Bence Jones protein
Decreased normal IgG

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3
Q

The M spike is indicative of….

A

myeloma or monoclonal findings

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4
Q

What Ig is present in 60% of cases?

A

IgG

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5
Q

What Ig is present in 20% of cases?

A

IgA

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6
Q

What Igs are rarely present?

A

IgD

IgE

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7
Q

What Ig is never present in multiple myeloma?

A

IgM

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8
Q

What is the bence jones protein?

A

Just the light chain, doesn’t show up in blood

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9
Q

Why is there a decrease in normal Ig in multiple myeloma?

A

Not entirely known. There are some normal plasma cells present but they aren’t producing antibodies.

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10
Q

How does a normal serum protein electrophoresis differ from a serum protein electrophoresis showing monoclonal bands (M protein)?

A

All the monoclonal plasma cells are making the same Ig so you can detect that Ig using electrophoresis. Monoclonal immunoglobin shows up as a BIG spike (m protein) in the gamma region.

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11
Q

What is seen in the blood of some one with multiple myeloma?

A

Anemia–NO plasma cells

rouleaux

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12
Q

What is rouleaux?

A

red cells stacked up on each other in little columns, like stacks of coins

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13
Q

What is seen in the marrow of someone w/ multiple myeloma?

A

Plasma cells >20% (normally 3%) arranged in big sheets

amyloid–d/t overproduction of light chains

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14
Q

What does amyloid look like on a slide?

A

Amyloid is a pink substance made up of different proteins. In this case it’s Igs. It can leave the bone marrow and go to the heart or kidney.

Pink and smudgy on hematoxylin and eosin staining, but when you stain it w/ congo red and look at it under flourescent light it looks apple green.

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15
Q

What are characteristic histological findings of multiple myeloma?

A

Plasma cells that are normally round have nucleus off to the side, chromatin is congregated to outside of nucleus, light spot where golgi is.

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16
Q

What are flame cells, russell bodies and Mott cells?

A

Collection of Igs.

It is hard for ER to get them out so it will become stuffed w/ Igs.

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17
Q

What are dutcher bodies?

A

invagination of cytoplasm into the nucleus w/ Igs inside.

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18
Q

Why does roleaux occur?

A

There are so many Igs in the serum that it overcomes the repellant force of RBCs causing them to stack.

19
Q

What is a solitary plasmacytoma?

A

Collection of neoplastic plasma cells in one solid tumor

20
Q

What is plasma cell leukemia?

A

Lots of malignant plasma cells in the blood (very rare)

21
Q

Why is waldenstrom macroglobulinemia unusual?

A

Unusual because it’s not really plasma cells, it’s lymphoma (not a myeloma)

22
Q

What are the characteristics of waldenstrom macroglobulinemia

A

Lymphoplasmacytoid lymphoma- lymphocytes that look like plasma cells
IgM (too much can sludge up the blood)
Hyperviscosity syndrome- capillaries at back of eye clog–> blood can’t get through> vision problems

23
Q

What is MGUS?

A

Monoclonal gammopathy of undetermined significance

24
Q

What are the characteristics of MGUS?

A

Small M spike w/ no myeloma sxs (small amt of monoclonal Igs, common in older pts)

Occasionally transforms into myeloma

25
Q

What plasma cells are normally in the lymph nodes?

A

plasmablasts

IgM

26
Q

What plasma cells are normally in the bone marrow?

A

activated B cells (IgG, IgA)

27
Q

What are the characteristics of normal plasma cells?

A

small in number
well-differentiated
characteristic phenotype
die by apoptosis

28
Q

Where are malignant plasma cells found?

A

plasmablasts in LN and BM (IgG and IgA)

29
Q

What are the characteristics of malignant plasma cells?

A

They do not differentiate into plasma cells, but continue to proliferate and accumulate in the marrow and produce large amts of Igs. Normal cell death doesn’t occur and they crowd out other cells.

30
Q

What percentage of pts present w/ bone pain in multiple myeloma? What causes this?

A

80%

Multiple lytic bone lesions

31
Q

What are the clinical features of MM?

A

Bone pain
Bruising or bleeding from decreased platelets (crowding out of precursors)
Infections from decreased levels of normal Igs
Hypercalcema (bone destruction

32
Q

What percentage of MM pts present w/ renal failure? Why?

A

50%

All the protein in the blood is hard on the glomeruli.

33
Q

What causes hyperviscosity syndrome?

A

Large amts of circulating Igs causing purpura, confusion, decreased vision
(common in ppl w/ increased IgM)

34
Q

What are the major causes of death in people w/ MM?

A

Infection, renal failure

35
Q

What is the classic triad associated w/ MM?

A

Anemia
bone pain
renal failure

36
Q

What is the criteria for diagnosis of MM?

A

BM w/ >20% plasma cells OR
Plasmacytoma + (monoclonal protein inserum/urine/lytic lesions)
Usual clincal features

37
Q

What other diseases may produce high levels of Igs?

A 
connective tissue diseases
chronic infections
carcinoma
lymphoma
leukemia
38
Q

How do you tx MM?

A

Symptomatic (active) disease treated immediately but there is no cure.

Treatment strategy is related to age and coexisting conditions (heart, lungs, kidney)

39
Q

What are the classical agents used to treat MM that help to reduce the M spike but don’t actually make people live longer?

A

Dexamethasone (steroid)
Melphalan- alk ag
Cyclophosphamide- alk ag

40
Q

What is the standard tx for ppl who are healthy?

A

Autologous peripheral blood stem cell transplant

41
Q

What is a Autologous peripheral blood stem cell transplant?

A

Hematpoietic SCs from peripheral blood
GF given after transplant
SAFE

but you can get contamination of autologous graft by myeloma cells

42
Q

What are newr agents used to tx MM?

A

Thalidomide
lenalidomide
bortezomib

43
Q

What drug significantly prolonged progression free and event free survival among pts w/ MM?

A

Lenalidomide

44
Q

What is the prognosis for people w/ MM?

A

3-4 years w/ conventional chemo

IHO Final- Krafts (11 decks)

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