Multiple Myeloma Flashcards
what is multiple myeloma?
malignancy of plasma cells
what two places can mm be measured in?
plasma or urine
what are the genetic factors implicated with mm?
- familial clusters of mm
- multiple genetic mutations (immunoglobulin gene rearrangements)
mm may be preceded by?
MGUS and smoldering mm
describe MGUS
- presence of monoclonal immunoglobulin in blood (≤3 g/dL)
- <10% clonal plasma cells in bone marrow
- absence of clinical manifestations of MM (e.g. end-organ damage)
- conversion rate of MGUS to MM is 1%/year
describe smoldering mm
- advanced premalignant stage
- monoclonal immunoglobulin in blood (≥3 g/dL)
- 10%-60% plasma cells in bone marrow
- no clinical manifestations of mm
what is a malignant plasma cell involved in unregulated production of a monoclonal antibody?
m-protein
mm cells supported by supportive bone marrow microenvironment that promotes further expansion of myeloma clones including:
IL-6
VEGF
IGF-1
NK-kB
is mm typically symptomatic or asymptomatic?
symptomatic
what are signs and symptoms of mm?
bone pain
fatigue
infection
neurologic symptoms
polyuria
n/v
what are labs associated with mm?
elevated m-protein
elevated SCr
hypercalcemia
low Hb
low albumin
elevated B2-microglobulin
elevated C-reactive protein
what is the main cytogenetic associated with mm?
Del (17p)
what is the acronym associated with mm?
CRAB:
hypercalcemia
renal insufficiency
anemia
bone lesions
for the staging and prognosis of mm what does the revised international staging system include?
serum B2-microglobulin
albumin
LDH
high-risk chromosomal abnormalities
describe stage I values of mm
serum β2 -microglobulin <3.5 mcg/mL
serum albumin ≥3.5 g/dL
no high-risk cytogenetics
normal LDH
describe stage II values of mm
not stage I or III
describe stage III values of mm
sSerum β2 -microglobulin ≥5.5 mcg/mL
high-risk cytogenetics [t(4;14), t(14;16), del(17p)] or
Elevated LDH
for newly diagnosed patients who can tolerate chemotherapy and are transplant eligible patients primary therapy may be followed by?
transplant and
maintenance therapy
initiating treatment depends on what?
if the patient is experiencing symptoms
is early conventional treatment benefical in patients with MGUS or smoldering mm?
no
but some new agents investigated in high-risk smoldering mm may improve survival and delay progression
what does the initial therapy for mm include?
dexamethasone
IMiDs
proteasome inhibitors
what is the frequently used regimen that is considered the standard of care for initial mm therapy?
bortezomib
lenalidomide
dexamethasone
initial therapy depends on whether the patient is what two things?
- symptomatic
- candidate for autologous HSCT
what are the eligibility factors for HSCT?
age
renal function
performance status
comorbidites
