MM

Question 1

Epidemiology

Answer 1

5-year relative survival rate 57.9%

More common in black, men

Median age of diagnosis: 69

Question 2

Pathophysiology

Answer 2

Abnormal clonal plasma cells infiltrating the bone marrow

Malignant plasma cell=M-protein

60% IgG

MGUS–>MM rate: 1% per year

Question 3

Presentation

Answer 3

CRAB

C: Calcium > 11.5 mg/dL

R: Renal dysfunction SCr > 2 mg/dL or CrCl < 40 mL/min

A: Anemia < 10 g/dL or 2 g/dL below normal

B: Bone one or more osteolytic lesions

Question 4

Diagnosis

Answer 4

Biopsy Proven disease
-Plasma cells in bone marrow
-Bony plasmacytoma
-Extramedullary plasmacytoma

Myeloma defining events:
-CRAB

Question 5

Induction therapy

Answer 5

Transplant candidate?
No–>3 drug regimen preferred

Yes–>Autologous stem cell transplant
3 drug regimen x 3-4 cycles

Question 6

Agents

Answer 6

Steroids
Lenalidomide, pomalidomide
Protease inhibitors: bortezomib, carfizomib, ixazomib

Question 7

Corner stone of therapy

Answer 7

Induction–>consolidation–>maintenance