Multiple Myeloma Flashcards
Diagnostic criteria for MGUS
M protein <3 g/dl
Clonal plasma cells in BM <10%
No SLiM-CRAB
Diagnostic criteria for Smoldering myeloma
M protein >3 g/dL or 500 mg/24 hrs in urine
BM plasma cells 10-60%
No SLiM-CRAB
Diagnostic criteria for multiple myeloma
M protein >3 g/dL or 500 mg/24 hrs in urine
BM plasma cells 10-60%
1+ SLiM CRAB feature
Which subtype of MGUS has highest risk of progression?
IgM
Monitoring of low-risk MGUS
Repeat SPEP and CBC, Cr in 6 months, then once every 2-3 years if stable
Monitoring of intermediate to high risk MGUS
Repeat labs in 6 months, then annually
Which patients newly diagnosed with MGUS should get a bone marrow biopsy
Everyone who is not low risk:
M protein >1.5 g/dL
FLC ratio >8
Non IgG type
3 risk factors for progression in SMM? How many do you need to be named high risk?
“20/2/20 model”
M protein >2
sFLC >20
BM PCs >20%
High risk is 2-3
Management of low risk SMM?
active surveillance
management of intermediate risk SMM?
active surveillance
Management of high risk SMM (2)
Len alone
Len + Dex
What is the R-ISS for MM?
Stage 1: Albumin >3.5 AND B2M <3.5
Normal LDH
No t(4;14), t(14;16), or del17p
Stage 3:
B2M >5.5 AND
high LDH OR
t(4;14), t(14;16), or del17p
Who should get VTE prophylaxis with ASA only?
1 or fewer VTE risk factors:
Obesity, previous VTE, CVC, pacemaker, surgery, assocaited cardiac, renal, diabetes, infection, or immobilization)
Definition of complete response?
No M protein
<5% BM PCs
Definition of progressive disease
M protein >25% increase
>10% BM PCs
Preferred induction chemotherapy for transplant eligible patient?
VRD
Preferred induction chemotherapy for high risk fit patient?
Dara-VRD
Preferred induction chemotherapy for newly diagnosed MM with myeloma renal dysfunction
CyBorD
What are myeloma-therapy specific- VTE risk factors that require someone to be on MLWH or warfarin?
High dose dex
Doxorubicin
Multiagent chemotherapy
Survival effect of autoSCT upfront vs delayed
Improved PFS, no improvement in OS
What medication improves survival as maintenance after autoSCT?
Lenalidomide
Management of CRS from BiTE?
Tocilizumab
What infectious prophylaxis is needed for all MM patients?
HSV, VZV, and PJP
When to treat therapy-related hypogammaglobulinemia? How to treat?
IgG <400 mg/dL, >2 severe infections, treatment resistant infections.
Treat with IVIG monthly
Treatment for solitary plasmacytoma without any plasma cells?
RT
Treatment for solitary plasmacytoma with some amount of clonal plasma cells (but not MM diagnostic)
RT +/- systemic therapy
MoA Isatuximab
CD38 inhibitor
High risk cytogenetics in myeloma (4)
t(4;14)
t(14;16)
Del 17p
1q21 gain/1q21 amp
good prognosis cytogenetics in MM (2)
t(6;14)
t(11;14)
Prognosis: t(6;14)
Good
Prognosis: t(11;14)
Good
Risk stratify: MYC translocation
High
Risk stratify: 1q21 gain
High
Risk Stratify: t(4;14)
High
Risk stratify: t(14;16)
High
