multiple myeloma

Question 1

multiple myeloma

Answer 1

-malignant ds of plasma cells in bone marrow
-MC bone cancer in adults
-older people
-RF- old, AA, men, pesticides, benzene (ptroleum), kaposi sarcoma herpes virus (IL-6 and HHV8)
-bad prognosis- ch13 deletion, hypodiploidy, T(4:14)

Question 2

symptoms of multiple myeloma

Answer 2

-CRAB
-Calcium level increased- osteoclasts destruct bone (>10)
-Renal failure- high BUN and Cr (>2)
-Anemia- fatigue, pallor, weak, wt loss (<10)
-Bone lesion- vertebral (MC), ribs, skull

-ROTI
-myeloma Related Organ or Tissue Impairment

-back pain
-respiratory infections
-renal failure
-proteinuria
-fractures
-dehydration
-lytic bone lesions on skull and vertebrae
-Recurrent infections- leukopenia and ineffective Ig production
-spinal cord compression
-hyperviscosity- HA, bruising

Question 3

multiple myeloma patho

Answer 3

->10% plasma cells in the bone marrow (normally <5%) -> produce abnormal antibodies
-high IgG and IgA
-protein accumulation -> kidney injury
-high paraprotein

Question 4

multiple myeloma dx

Answer 4

-serum protein electrophoresis- monoclonal (M) protein spike- IgG MC
-non-secretory MM has no M protein
-urine protein electrophoresis- bence-jones proteins (kappa or lambda light chains)
-absence of light chains in urine
-CBC- rouleaux formation- RBCs in stack of coin (high ESR)
-skull radiograph- punched out lytic lesions (14 from skull to knee)
-bone marrow aspiration- plasmacytosis >10% -> DEF DX

-use durle-salmon staging system

Question 5

multiple myeloma tx

Answer 5

-autologous stem cell transplant + chemo
-radiation
-bisphosphonates

-bortezomib
-lenalidomide

Question 6

classification of myeloma

Answer 6

-1. monoclonal gammopathy of undetermined significance (MGUS)- <10% plasma, M-protein <3, no CRAB

-2. asymptomatic multiple myeloma
-smoldering (SMM)- >3 M protein and/or >10% plasma, no CRAB
-indolent (IMM)- mild anemia or small lytic bone lesions

-3. symptomatic multiple myeloma (MM)

Question 7

waldenstrom macroglobulinemia and IgM multiple myeloma

Answer 7

-lymphoplasmacytic B-cell lymphoma -> excess IgM
-clonal B cell IgM production
-asymptomatic
-CD56 - ve
-CD19, and CD20 + ve
-if sx -> organomegaly, hyperviscosity, anemia (OVA)
-> leg ulcers, raynauds, retinal hemorrhage, white matter changes in brain, bleeding

-dx-
-serum protein electrophoresis- IgM monocloncal spike
-bone marrow bx- >10% lymphoplasmacytic infiltrate (exclude CLL)- dutcher bodies
-rouleaux

-tx-
-observation if asymptomatic
-chemo for symptoms -> treatable but not curative

Question 8

AL amyloidosis

Answer 8

-plasma cell proliferation
-<20% bone marrow plasma
-no lytic bone lesions
-modest amount of Bence jones proteinuria
-nephrotic syndrome, HF, hepatomegaly

Question 9

structural/obstructive oncological emergency

Answer 9

-SVC syndrome- JVD, plethora, mediastinal widening, pleural effusion

-pericardial effusion/tamponade- leukemia, lymphoma -> hypotension, HVD, muffled heart sounds (BECKS), water bottle sign

-spinal cord compression- MM, lymphoma

-cauda equina syndrome- below L1/2- saddle ana, loss of anal sphincter (PR exam), impotence, bladder dys, sciatica -> dexameth

-high ICP- CT, MRI -> dexameth

-urinary tract obstruction

-hemoptysis

-airway obstruction

Question 10

metabolic/hormonal oncological emergency

Answer 10

-hypercalcemia- >11, lymphoma, myeloma, albumin <4 will obscure value -> polydipsia, polyuria, AMS, shorten QT, osborn wave

-SIADH

-Lactic acidosis

Question 11

secondary to complication arising from tx oncological emergency

Answer 11

-!tumor lysis syndrome- toxicity from cell breakdown -> hyperuricemia, hyperphosphatemia, hypocalcemia, hyperkalemia

-hemorrhagic cystitis

-anaphylaxis to chemo

-neutropenic fever- neutrophils <1500 and fever from chemo immunosuppression -> bacteria from invasive procedures
-Granulocyte Colony Stimulating Factor (GCSF) -> raise neutrophils

Answer 12