multiple myeloma

Question 1

thalidomide adverse effects

Answer 1

neuropathy, sedation,DVT, rash, constipation; NOT thrombocytopenia

Question 2

thrombocytopenia

Answer 2

lenalidomide, bortezomib ,

Question 3

t(4;14) translocation

Answer 3

particularly suited to VMP (bortez, melphalan, pred).

Question 4

first line agents

Answer 4

VMP>MP for OS; MP>TD

Question 5

thal/len adverse effects

Answer 5

high rate of DVT 10-20% risk even with ASA; thal also MI but not myopathy;

Question 6

bortez adverse effects

Answer 6

neuropathy, fatigue, VZV reactivation, GI symptoms, NOT DVT; can reduce neuropathy with once-weekly, and SQ instead of IV

Question 7

smoldering MM

Answer 7

IgG/A>3 or clonal plasma>10% BM; absence of CRAB

Question 8

VGPR

Answer 8

M-component detectable by fixation but not electrophoresis, or >90% reduction in serum, plus urine<100mg/24hr

Question 9

ISS staging

Answer 9

1: b2m3.5; III b2m>5.5

Question 10

DSS staging high stage

Answer 10

1 or more advanced bone lesion, Hgb<8.5, increased calcium, high monoclonal protein production

Question 11

transplant ineligible patients treatment

Answer 11

VMP>MP, RD, VRD, VCD. Can use risk-adapted approach: RD for low risk, VCD for intermediate, VRD for high

Question 12

high risk MM

Answer 12

t(14,16), T(14,20), 17p-: 14 first sux!

Question 13

standard risk MM

Answer 13

hyperdiploid; T(11;14) T(6;14)–> 14 last is a blast

Question 14

t(4;14)

Answer 14

two fours and your in between

Question 15

V v. L

Answer 15

V=neuropathy; L=DVT

Question 16

maintenance therapy

Answer 16

consider bortezomib maintenance for high/int risk patients; lenolidomide may benefit but high rate of secondary malignancies and uncertain OS benefit.

Question 17

thal/len skin rash

Answer 17

avoid sulfas and allopurinol co-administration

Question 18

thyoiditis

Answer 18

thal/len

Question 19

CD10-CD19+CD20+CD23-,sIgM+

Answer 19

WM–> Tx ritux or combination with ritux