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Z Year3 Haem Conditions > Multiple myeloma > Flashcards

Multiple myeloma Flashcards

1
Q

What is multiple myeloma?

A

neoplastic monoclonal proliferation of bone marrow plasma cells resulting in excessive monoclonal immuboglobulin production

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2
Q

What are RF for multiple myeloma?

A
  1. MGUS
  2. Abnormal free light-chain ratio
  3. Age >70
  4. Afrocaribbeans
  5. Ionising radiation
  6. Agricultural work
  7. HIV
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3
Q

What are symptoms and signs of multiple myeloma?

A
  1. High calcium
  2. Renal failure
  3. Anaemia (60-70% patients)
  4. Bone lesions (60-70% mostly in back)
    - CRAB
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4
Q

What is differential diagnosis for multiple myeloma?

A
  1. MGUS
  2. Solitary plasmacytoma
  3. Amyloidosis
  4. Heavy chain disease
  5. NHL
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5
Q

What bloods would you do for multiple myeloma?

A
  1. ESR
  2. CRP
  3. Urea
  4. Creatinine
  5. Normal ALP
  6. Serum Calcium
  7. FBC
  8. Albumin
  9. Serum beta4-microglobulin
  10. blood film
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6
Q

What would ESR be in multiple myeloma?

A

high

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7
Q

What would serum calcium be in multiple myeloma?

A

hyper in 30%

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8
Q

What does blood film show in multiple myeloma?

A

rouleaux formation

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9
Q

What special tests are done for multiple myeloma?

A
  1. Whole-body lost dose CT
  2. Skeletal survey
  3. Serum free light-chain assay
  4. Bone marrow aspirate and biopsy
  5. Serum/urine electrophoresis
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10
Q

What test is diagnostic for multiple myeloma?

A

Serum/urine electrophoresis:

  • serum paraprotein (IgG or IgA)
  • Urinary Bence Jones proteins
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11
Q

What does bone marrow aspirate and biopsy show in multiple myeloma?

A

monoclonal plasma cell infiltration in the bone marrow ≥10%

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12
Q

What is treatment for acute multiple myeloma transplant candidate?

A
  • 1st line: Induction therapy
  • Plus: DVT prophylaxis and SCT
  • Adjunct: Stem cell mobilisation and conditioning regimen and supportive care
  • Bone disease: bisphosphonates or denosumab and analgesics
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13
Q

What is acute management for multiple myeloma non-transplant candidate?

A
  • 1st line: non transplant therapy
  • Plus: DVT prophylaxis
  • Adjunct: analgesics
  • Bone disease: bisphosphonates or denosumab and analgesics
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14
Q

What is chronic treatment for multiple myeloma?

A

1ST LINE: Maintenance strategies

DVT prophylaxis and supportive care

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15
Q

What are possible complications ofr multiple myeloma?

A
  1. Bone pain
  2. Fractures of vertebral bodies
  3. Hypercalcaemia
  4. Anaemia
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16
Q

What staging system is used in multiple myeloma?

A

Durie and Salmon staging system

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17
Q

What does the high calcium in MM lead to?

A

bones, stones, abdominal groans

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18
Q

How common is renal failure in MM and what does it mean?

A

20% and worse prognosis

19
Q

Why is there anaemia in MM?

A

Anaemia due to bone marrow crowing and production of monoclonal Ig also crowds out production of normal polyclonal Ig so recurrent infections

20
Q

Why are there bone lesions in MM?

A

increased osteoclast activation so back/rib pain

21
Q

What happens in MM with which cells?

A
  1. Proliferation of plasma cells

2. Production of a monoclonal immunoglobin (IgG or IgA) – not polyclonal like normal

22
Q

Why is ALP important in MM?

A

normal in MM but high in blood cancers so good to differentiate

23
Q

What would you see is serum/urine electrophoresis in MM?

A

Urinary Bence Jones proteins

24
Q

How does rouleaux formation actually look like on blood film?

A

RBC stacked up like coins

25
Q

What does bone arrow aspirate show on MM?

A

plasma cells bone marrow ≥10%

26
Q

What does MGUS stand for?

A

monoclonal gammopathy of unknown significance

27
Q

What is MGUS?

A

premalignant condition with accumulation of some monoclonal plasma cells

28
Q

What can MGUS lead to?

A

1% acquire additional mutations so can lead to multiple myeloma

29
Q

What is absent if MGUS but present in MM?

A

ABSENT CRAB features

30
Q

Why is there renal failure in MM?

A
  • cast nephropathy

- due to high Serum free light chains and Bence jones proteinuria

31
Q

How does cast nephropathy happen?

A
  1. FLCs activate inflammatory mediators in the proximal tubule epithelium leads to proximal tubule necrosis
  2. Fanconi syndrome (renal tubules acidosis) with FLC crystal deposition
32
Q

What may you see on x ray for MM?

A

punched out lesions

33
Q

What may be seen in special tests?

A

M spike or paraprotein

34
Q

Why is there an M spike in MM?

A

Produce excess of monoclonal (kappa or lamda) serum free light chains)

35
Q

What are urinary bence jones?

A

urine monoclonal free light chains

36
Q

What would blood results be in MM?

A
  1. Macroctyic anaemia
  2. Low reticulocytes, low WBC, low lymphocytes, low neutrophils and low platelets
  3. High ESR
  4. High creatinine
  5. low albumin
  6. high globulins
  7. high Ca
37
Q

What is paraprotein and immune paresis?

A
  1. Paraprotein: monoclonal excess of intact Ig molecule

2. Immune paresis: get lower levels of other Ig e.g. lower IgA and IgM

38
Q

How do you manage the cord compression?

A

MRI scan and dexamethasone

39
Q

How may hypercalcaemia present?

A

drowsiness, constipation, fatigue, muscle weakness, AKI

40
Q

What is the management for hypercalcaemia?

A

fluids, steroid, zolendronic acid

41
Q

What medications can be used in MM?

A
  1. Steroids
  2. Classic cystostatic drugs e.g. melphalan
  3. IMIDs
  4. MoAbs i.e. daratumumab
  5. Proteasome inhibitors (velcade)
42
Q

What are examples of IMIDs?

A

(immunomodulatory drugs): e.g. thalidomide (teratogenic), lenalidomide, pomalidomide

43
Q

How does an autologous haematopoetic stem cell transplant work?

A
  1. Stem cell collection from the blood and storage
  2. High dose melphalan to kill myeloma cells
  3. Re-infusion of stem cells to rescue blood formation
44
Q

What blood test should you not forget for MM and why?

A

Sometimes only sign of myeloma is light chains!

Z Year3 Haem Conditions (18 decks)

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