Multiple Myeloma

Question 1

Definition MGUS versus smoldering MM versus MM

Answer 1

MGUS

• M spike < 3
• % PC in BM < 10%
• No CRAB Sx

Smoldering MM

• M Spike > 3
• % PC in BM > 10% (but <60%)
• No CRAB Sx
• Bence Jones 500mg/24 hours or greater

MM

• M Spike > 3
• % PC in BM > 10%
• YES CRAB Sx

Question 2

SLIM CRAB

Answer 2

S - sixty: 60% PC in BM
Li - light chains: K/L > 100
M - MRI lesions: > 1 focal BM lesion on MRI at least 5mm (diff than lytic lesion)
CRAB: CRAB sx present

Question 3

RISS staging MM

Answer 3

stage 1: B2M < 3.5 and albumin > 3.5, and standard risk chromo abnorm or serum LDH > ULN

stage 2: not 1 or 3

stage 3: B2M > 3.5 and high risk cytogenetics or LDH > ULN

high risk features – high LDH, FISH del(17p), t(4;14), t(14;16)

Question 4

Proteosome inhibitors

Answer 4

Bortezomib/Velcade (IV/SC)
Carflizomib (IV)
Ixazomib (PO)

AEs: neuropathy, HSV reactivation

Question 5

Immune modulators in MM

Answer 5

Thalidomide
Lenalidomide/Revlimid (PO)
Pomalidomide (PO)

AEs: Renal dosing (though pom can be given at any renal level), VTE, Myelosuppression, Secondary malignancy

Question 6

amyloid worse risk when treated with bortezimib

Answer 6

when pts havet(11;14), they do worse

Question 7

Poor risk genetic findings for MM

Answer 7

FISH: del(17p), t(4;14), t(14;16), t(14;20), amp 1q21