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Heme boards > Multiple myeloma > Flashcards

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
Q

Indication for venetoclax in myeloma

A

t(11;14)

26
Q

bortezomib mechanism

A

proteasome inhibitor

27
Q

Solitary plasmacytoma treatment

A

XRT

28
Q

MGUS threshold in terms of paraprotein size 1) serum 2) UPEP

A

Less than 3 g/dL
Urine protein less than 500 mg in 24 hours

29
Q

High risk criteria for MGUS

A

1) M spike greater than 1.5
2) Non-IgG M protein
3) Abnormal FLC ratio (>1.65 or <0.26)

30
Q

Smoldering criteria

A

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
Q

Risk tool and interpretation for smoldering myeloma progression to myeloma 2) what is considered high risk

A

20/2/20
2 = M spike >2
20 = plasma cells >20
20 = FLC >20
*IF >2 of above, this is high risk smoldering

32
Q

SLiM criteria

A

S = >60% plasma cells in marrow
L = FLC >100
M = MRI w/ lesion >5mm

33
Q

CRAB criteria

A

Calcium >11
R = Cr >2.0 or CrCl <40
hgb <10
Bone lesion on any imaging

34
Q

Clinical significance of t(11;14) translocation

A

Role for single agent venetoclax

35
Q

First step and second step in thinking about induction therapy for myeloma

A
  • Decide if patient is transplant eligible or ineligible
  • IF eligible, then need quadruplet regimen regardless of cytogenetics
    IF ineligible, triplet
36
Q

Transplant eligibility criteria in myeloma

A

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
Q

Clinical benefit of lenalidomide maintenance

A

PFS, not OS

38
Q

Board answer for induction therapy for fit pt in early 80s

A

VRD, not len/dex

39
Q

Preferred induction at UMass for transplant ineligible

A

D-VRD (Preferred at Umass for transplant ineligible as well, deepen response, not that much added toxicity)

40
Q

What factors are incorporated into IMPEDED VTE risk score for thrombprophylaxis in myeloma

A
  • BMI
  • use of IMID
  • use of dex
  • prior VTE
41
Q

Risk of progression of smoldering myeloma

A

10% per year for 5 years, 3% per year for next 5 years, and 1% per year thereafter

42
Q

What does R-ISS staging system include?

A
  • albumin
  • beta-2
  • LDH
  • FISH panel on BMB
    *The Revised system incorporated FISH abnormalities
43
Q

How does jaw osteonecrosis present?

A

area of exposed bone in maxillofacial region that does not heal

44
Q

Management of osteonecrosis

A
  • oral hygiene
  • topical antibiotic mouth rinses
  • systemic antibiotics
45
Q

Additional RF’s for progression in smoldering myeloma incorporated into the PETHEMA model

A
  • ## immunoaresis
46
Q

Non-IgM MGUS risk of progression

A

0.5% per year

47
Q

LIght-chain MGUS risk of progression

A

0.3% per year

48
Q

Low-intermediate risk of progression over 20 years

A

21%

49
Q

high-intermediate risk of progression over 20 years

A

37%

50
Q

high risk of progression MGUS over 20 years

A

58%

51
Q

Low risk of progression over 20 years

A

5%

52
Q

When BMB + PET is indicated by the books for MGUS pts

A

anything above low risk (so low-intermediate and higher)

53
Q

Percentage of smoldering patients that will progress to myeloma within the first 5 years

A

50% (10%/year)

54
Q

Additional RF’s for progression from smoldering to myeloma incorporated into the PETHEMA model

A

> 95% abnormal plasma cells by flow
- immunoparesis

55
Q

Clinical benefit of len/dex for smoldering

A
  • demonstrated OS but controversial since MRI not included, some may have actually had myeloma
56
Q

Stringent CR vs CR in myeloma

A

stringent = NO plasma cells in marrow
CR = <5% plasma cells in marrow

57
Q

VGPR in myeloma

A

> 90% reduction of M protein

58
Q

Clinical benefit of upfront vs. delayed transplant

A

PFS alone

59
Q

Clinical benefit of len maintenance

A

OS

60
Q

SE’s of bispecifics in myeloma

A
  • CRS
  • infectious risk
61
Q

Bispecifics approved for myeloma

A
  • teclistamab
  • talquetamab
  • elranatamab

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