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NM By Myself > MM NM > Flashcards

MM NM Flashcards

1
Q

Bone marrow location

A

Skull
Clavicle
Sternum
Humerus
Pelvis
Femur
Vertebrae

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2
Q

Associated disease

A

Myelofibrosis

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3
Q

MM mechanism

A

Activate osteoclasts
Inhibit osteoblast
Bone resorption
Hypercalcemia

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4
Q

Presentation

A

Bone pain
Pathologic fracture
Beta2 microglobulin
M-protein IgG>IgA - - increase viscosity in eye and CNS - - visual impairment, hearing loss, dizziness
LDH
Spinal cord compression - - collapse of vertebral body in response to therapy
Immunodeficiency

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5
Q

MGUS

A

<10% plasma cells
Serum M-protein <3 g/dL
Normal bone on X-ray

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6
Q

Smoldering MM (stage IA)

A

> 10% plasma cells
Serum M-protein >3 g/dL or urine M-protein >1 g/dL
Single plasmacytoma

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7
Q

End organ damage CRAB

A

Calcium elevation
Renal insufficiency
Anemia
Bone abnormalities

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8
Q

MM characteristics

A

> 10% plasma cells or plasmacytoma
End organ damage

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9
Q

MM stage I lab

A

Hb >10 g/dL
Calcium <12 mg/dL
IgG <5 g/dL
IgA <3 g/dL
Urine M-protein < 4 g/24 h

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10
Q

MM stage IB

A

< 5 focal lesions >5 mm
On T1 MRI: micronodular or salt and pepper

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11
Q

MM stage III lab

A

Hb <8.5 g/dL
Calcium >12 mg/dL
IgG >7 g/dL
IgA >5 g/dL
Urine M-protein >12 g/24 h

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12
Q

MM stage II

A

5-20 focal lesions
On T1 MRI : contrast between vertebral bone marrow and disc

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13
Q

MM stage III

A

> 20 focal lesions
On T1 MRI : T1 signal less than disc

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14
Q

MM stage A

A

Creatinine <2 mg/dL
No extramedullary disease

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15
Q

MM stage B

A

Creatinine >2 mg/dL
Extramedullary disease

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16
Q

MGUS = monoclonal gammopathy of undetermined significance
Progression

A

Progression to MM 1% per year or Waldenstrom macroglobulinemia
Can progress to Primary Amyloidosis, CLL, lymphoma

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17
Q

MGBS

A

Macroglobulinemia of borderline significance
Higher risk of progression
10-30% plasma cells

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18
Q

SMM = smoldering MM

A

Asymptomatic (no end organ damage)
Higher risk of progression to MM

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19
Q

MM overview

A

Symptomatic
CRAB
Non-secretory - - no elevated M-protein
Micromolecular - - only light chains secreted
IgD MM

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20
Q

POEMS sy 1%

A

Polyneuropathy - symmetric, distal
Organomegaly
Endocrinopathy
M-protein
Skin changes + sclerotic bone lesions

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21
Q

Plasma cell leukemia

A

> 20% plasma cells

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22
Q

PCLI

A

Plasma cell labeling index
Correlated with neoangiogenesis
MGUS and SMM - - <1% PCLI
40% MM normal PCLI

23
Q

Solitary plasmacytoma image

A

MRI, PET, DMSA

24
Q

RAS = Radiographic skeletal survey

A

Punched - out Lytic lesions
Osteopenia
Fracture
MRI, PET
Bone scan insensitive
CT more sensitive - - >5 mm

25
Q

Bone scan positive

A

Osteoblastic response to compression fracture or pelvic fracture
Soft tissue calcification
Tumor associated Amyloidosis

26
Q

Ga67- citrate

A

Areas of active tumor
Low resolution
Multi day

27
Q

Tc-DMSA

A

Accumulate in plasmacytoma

28
Q

Tc-Sestamibi

A

Semiquantitative degree of bone marrow infiltration
Always negative in MGUS
False negative due to overexpression of P-glycoprotein (ass with multidrug resistant MM)
<MRI in spine
Replace Tl-Chloride

29
Q

FDG indication

A

Initial staging
Early bone marrow infiltration (false positive young and anemia)
Extramedullary involvement (poor prognosis)
Negative in MGUS, MM stage I

30
Q

Active transformed plasma cells

A

Glucose avid
Focal or diffuse uptake

31
Q

Lesions <10mm

A

Not detected on FDG

32
Q

FDG after surgery

A

At least 4 weeks

33
Q

FDG after radio

A

2-3 months

34
Q

Impetus = interpretative criteria for FDG in MM

A

Metabolic state of bone marrow
Number and site of positive lesions
Extramedullary disease
Paramedullary disease
Fractures

35
Q

Choline

A

Higher sensitivity than FDG
High physiological liver uptake

36
Q

C-Methionine

A

Incorporate into Ig
New Lytic lesions positive, recurring - negative

37
Q

FLT

A

High uptake in myelodysplasia
Lower-absent uptake in MM, myelofibrosis, aplastic anemia

38
Q

MGUS treatment

A

Long term observation

39
Q

Solitary plasmacytoma treatment

A

Radio

40
Q

MM treatment

A

Systemic therapy

41
Q

Effective response

A

FDG rapidly declines

42
Q

Persistent positive FDG

A

Early recurrence

43
Q

M-protein

A

IgG 52 %
IgA 21 %

44
Q

At diagnosis

A

10% diffuse osteopenia

45
Q

Plasmacytoma

A

Solid lesion + soft tissue outside of bone or from preexistent bone lesion
No systemic spread

46
Q

Minimum criteria for MM

A

At least 10% plasma cells
Or M-protein >3 g/dL in serum or >1g excreted in 24h urine

47
Q

Poor prognosis

A

Translocation
Chromosomal alteration
Elevated PCLI

48
Q

High risk SMM

A

Should be treated
80% CRAB in a short period

49
Q

FDG focal uptake in MGUS

A

Transformation into active myeloma

50
Q

> 10 spine lesions on MRI

A

6-11 fold risk of fracture

51
Q

Radionuclide therapy

A

Anti CD45, CD66, CD138
CXCR4

52
Q

Epidemiology

A

Number 1 primary tumor of bone

53
Q

MRI detect

A

Iron overload
Amyloid
Marrow hyperplasia

54
Q

Low sensitivity MRI

A

Sternum and ribs
PET better

NM By Myself (25 decks)

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