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Multiple myeloma Flashcards

1
Q

Indication for SRE ppx in myeloma

A

All myeloma patients regardless of presence of bony disease

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2
Q

1) RF’s for myeloma 2) gender RF

A
  • older age
  • African American
  • male
  • obesity
  • FH
  • XRT
  • *benzene
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3
Q

High risk cytogenetics in myeloma

A

t(4;14)
t(14;16)
t(14;20)
del 17p
1q gain

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4
Q

Plasma cell leukemia diagnostic threshold

A

Greater than 20% circulating plasma cells

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5
Q

What is VTD-PACE?

A

Velcade
Thalidomide
Dexamethasone
Cisplatin
Doxorubicin
Cytoxan
Etoposide

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6
Q

Definition of disease progression in myeloma

A

Greater than 25% increase in M protein

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7
Q

Drugs to avoid pre-transplant

A

(alkylating agents), eg cytoxan
and
- prolonged lenalidomide

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8
Q

Dex dosing in myeloma

A

40 mg once weekly

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9
Q

velcade SE’s

A
  • neuropathy
  • thrombocytopenia
  • rash
  • zoster
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10
Q

Velcade hepatic or renal dose adjustment?

A
  • needs hepatic dose adjustment
  • does not require renal dosing
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11
Q

1) carfilzomib SE to know 2) more or less neuropathy than velcade?

A
  • cardiac
  • less neuropathy than velcade
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12
Q

ixazomib SE profile vs. velcade

A
  • less neuropathy but more GI toxicity (oral)
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13
Q

Lenalidomide SE profile

A
  • VTE
  • myelosuppression
  • rash
  • fatigue
  • secondary malignancy
  • teratogenic (hence REMS)
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14
Q

Pomalidomide SE profile

A
  • VTE
  • cytopenias
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15
Q

Daratumumab mechanism

A

CD38 monoclonal ab

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16
Q

Isatuximab mechanism

A

CD38 monoclonal ab

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17
Q

elotuzumab mechanism

A

SLAM-F7

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18
Q

elotuzumab SE’s to know

A
  • infusion reactions
  • infection risk
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19
Q

selinexor mechanism

A

oral selective inhibitor of nuclear export

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20
Q

selinexor SE’s

A
  • GI toxicity
  • cytopenias
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21
Q

Belantamab mafodotin mechanism

A

BCMA

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22
Q

Belantamab mafodotin SE to know

A
  • ocular toxicity
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23
Q

CAR-T target in myeloma

A
  • BCMA
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24
Q

CAR-T approved for myeloma

A

Idecabtagene vicleucel (Ide-cel)
ciltacabtagene autoleucel (Cilta-cel)

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25
Indication for venetoclax in myeloma
t(11;14)
26
bortezomib mechanism
proteasome inhibitor
27
Solitary plasmacytoma treatment
XRT
28
MGUS threshold in terms of paraprotein size 1) serum 2) UPEP
Less than 3 g/dL Urine protein less than 500 mg in 24 hours
29
High risk criteria for MGUS
1) M spike greater than 1.5 2) Non-IgG M protein 3) Abnormal FLC ratio (>1.65 or <0.26)
30
Smoldering criteria
M protein greater than 3.0 or plasma cells greater than 10% (but less than 60) *or urine greater than 500 without end organ damage
31
Risk tool and interpretation for smoldering myeloma progression to myeloma 2) what is considered high risk
20/2/20 2 = M spike >2 20 = plasma cells >20 20 = FLC >20 *IF >2 of above, this is high risk smoldering
32
SLiM criteria
S = >60% plasma cells in marrow L = FLC >100 M = MRI w/ lesion >5mm
33
CRAB criteria
Calcium >11 R = Cr >2.0 or CrCl <40 hgb <10 Bone lesion on any imaging
34
Clinical significance of t(11;14) translocation
Role for single agent venetoclax
35
First step and second step in thinking about induction therapy for myeloma
- Decide if patient is transplant eligible or ineligible - IF eligible, then need quadruplet regimen regardless of cytogenetics IF ineligible, triplet
36
Transplant eligibility criteria in myeloma
age <77 (Assuming not 80 and running marathons but moving away from HCT…) AND no decompensated cirrhosis AND no NYHA3/4 CHF AND EF>40% AND ECOG 0-2
37
Clinical benefit of lenalidomide maintenance
PFS, not OS
38
Board answer for induction therapy for fit pt in early 80s
VRD, not len/dex
39
Preferred induction at UMass for transplant ineligible
D-VRD (Preferred at Umass for transplant ineligible as well, deepen response, not that much added toxicity)
40
What factors are incorporated into IMPEDED VTE risk score for thrombprophylaxis in myeloma
- BMI - use of IMID - use of dex - prior VTE
41
Risk of progression of smoldering myeloma
10% per year for 5 years, 3% per year for next 5 years, and 1% per year thereafter
42
What does R-ISS staging system include?
- albumin - beta-2 - LDH - FISH panel on BMB *The Revised system incorporated FISH abnormalities
43
How does jaw osteonecrosis present?
area of exposed bone in maxillofacial region that does not heal
44
Management of osteonecrosis
- oral hygiene - topical antibiotic mouth rinses - systemic antibiotics
45
Additional RF's for progression in smoldering myeloma incorporated into the PETHEMA model
- immunoaresis -
46
Non-IgM MGUS risk of progression
0.5% per year
47
LIght-chain MGUS risk of progression
0.3% per year
48
Low-intermediate risk of progression over 20 years
21%
49
high-intermediate risk of progression over 20 years
37%
50
high risk of progression MGUS over 20 years
58%
51
Low risk of progression over 20 years
5%
52
When BMB + PET is indicated by the books for MGUS pts
anything above low risk (so low-intermediate and higher)
53
Percentage of smoldering patients that will progress to myeloma within the first 5 years
50% (10%/year)
54
Additional RF's for progression from smoldering to myeloma incorporated into the PETHEMA model
>95% abnormal plasma cells by flow - immunoparesis
55
Clinical benefit of len/dex for smoldering
- demonstrated OS but controversial since MRI not included, some may have actually had myeloma
56
Stringent CR vs CR in myeloma
stringent = NO plasma cells in marrow CR = <5% plasma cells in marrow
57
VGPR in myeloma
>90% reduction of M protein
58
Clinical benefit of upfront vs. delayed transplant
PFS alone
59
Clinical benefit of len maintenance
OS
60
SE's of bispecifics in myeloma
- CRS - infectious risk
61
Bispecifics approved for myeloma
- teclistamab - talquetamab - elranatamab

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