Multiple Myeloma

Question 1

Diagnostic criteria for MGUS

Answer 1

M protein <3 g/dl
Clonal plasma cells in BM <10%
No SLiM-CRAB

Question 2

Diagnostic criteria for Smoldering myeloma

Answer 2

M protein >3 g/dL or 500 mg/24 hrs in urine
BM plasma cells 10-60%
No SLiM-CRAB

Question 3

Diagnostic criteria for multiple myeloma

Answer 3

M protein >3 g/dL or 500 mg/24 hrs in urine
BM plasma cells 10-60%
1+ SLiM CRAB feature

Question 4

Which subtype of MGUS has highest risk of progression?

Answer 4

IgM

Question 5

Monitoring of low-risk MGUS

Answer 5

Repeat SPEP and CBC, Cr in 6 months, then once every 2-3 years if stable

Question 6

Monitoring of intermediate to high risk MGUS

Answer 6

Repeat labs in 6 months, then annually

Question 7

Which patients newly diagnosed with MGUS should get a bone marrow biopsy

Answer 7

Everyone who is not low risk:
M protein >1.5 g/dL
FLC ratio >8
Non IgG type

Question 8

3 risk factors for progression in SMM? How many do you need to be named high risk?

Answer 8

“20/2/20 model”
M protein >2
sFLC >20
BM PCs >20%
High risk is 2-3

Question 9

Management of low risk SMM?

Answer 9

active surveillance

Question 10

management of intermediate risk SMM?

Answer 10

active surveillance

Question 11

Management of high risk SMM (2)

Answer 11

Len alone
Len + Dex

Question 12

What is the R-ISS for MM?

Answer 12

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

Question 13

Who should get VTE prophylaxis with ASA only?

Answer 13

1 or fewer VTE risk factors:
Obesity, previous VTE, CVC, pacemaker, surgery, assocaited cardiac, renal, diabetes, infection, or immobilization)

Question 14

Definition of complete response?

Answer 14

No M protein
<5% BM PCs

Question 15

Definition of progressive disease

Answer 15

M protein >25% increase
>10% BM PCs

Question 16

Preferred induction chemotherapy for transplant eligible patient?

Answer 16

VRD

Question 17

Preferred induction chemotherapy for high risk fit patient?

Answer 17

Dara-VRD

Question 18

Preferred induction chemotherapy for newly diagnosed MM with myeloma renal dysfunction

Answer 18

CyBorD

Question 19

What are myeloma-therapy specific- VTE risk factors that require someone to be on MLWH or warfarin?

Answer 19

High dose dex
Doxorubicin
Multiagent chemotherapy

Question 20

Survival effect of autoSCT upfront vs delayed

Answer 20

Improved PFS, no improvement in OS

Question 21

What medication improves survival as maintenance after autoSCT?

Answer 21

Lenalidomide

Question 22

Management of CRS from BiTE?

Answer 22

Tocilizumab

Question 23

What infectious prophylaxis is needed for all MM patients?

Answer 23

HSV, VZV, and PJP

Question 24

When to treat therapy-related hypogammaglobulinemia? How to treat?

Answer 24

IgG <400 mg/dL, >2 severe infections, treatment resistant infections.

Treat with IVIG monthly

Question 25

Treatment for solitary plasmacytoma without any plasma cells?

Answer 25

RT

Question 26

Treatment for solitary plasmacytoma with some amount of clonal plasma cells (but not MM diagnostic)

Answer 26

RT +/- systemic therapy

Question 27

MoA Isatuximab

Answer 27

CD38 inhibitor

Question 28

High risk cytogenetics in myeloma (4)

Answer 28

t(4;14)
t(14;16)
Del 17p
1q21 gain/1q21 amp

Question 29

good prognosis cytogenetics in MM (2)

Answer 29

t(6;14)
t(11;14)

Question 30

Prognosis: t(6;14)

Answer 30

Good

Question 31

Prognosis: t(11;14)

Answer 31

Good

Question 32

Risk stratify: MYC translocation

Answer 32

High

Question 33

Risk stratify: 1q21 gain

Answer 33

High

Question 34

Risk Stratify: t(4;14)

Answer 34

High

Question 35

Risk stratify: t(14;16)

Answer 35

High