Multiple Myeloma

Question 1

What is multiple myeloma a poliferation of? Monoclonal or polyclonal?

Answer 1

monoclonal plasma cells

Question 2

So if you have monoclonal proliferation of plasma cells, what else do you have?

Answer 2

monoclonal gammopathy

Question 3

What happens to the bone in multiple myeloma?

Answer 3

osteolytic lesions

Question 4

What’s the main lab finding you see in multiple myeloma?

Answer 4

an M-spike - when you do protein electrophoresis you see a monoclonal gammopathy in the gamma region

Question 5

Which Ig is the most common type produced in multiple myeloma? Next? Which one is never in MM?

Answer 5

IgG in 60% of cases
IgA in 20% of cases
Rarely IgD and IgE
Never IgM

Question 6

Why should you also do a protein electrophoresis on the urine if the blood is negative?

Answer 6

Because if the gammopathy is just light chains, those will be excreted in the kidneys and wont be in high concentrations in the blood
(called Bence-Jones protein)

Question 7

What happens to the normal Ig in MM?

Answer 7

it decreases - we don’t know why

Question 8

What will happen in the blood in MM?

Answer 8

anemia because the blood cells get kicked out of hte bone marrow

Rouleaux

No plasma cells in the blood oddly enough

Question 9

What will happen in the marrow in MM?

Answer 9

lots of plasma cells

amyloid

Question 10

What are flame cells?

Answer 10

plasma cells that stain oddly - look like flames - classic for MM

Question 11

What are RUssell bodies?

Answer 11

It’s hard for the RER to get the abnormal Ig out, so the ER tends to get stuffed with the immunoglobulins and you see the stuffed areas - russell bodies

Question 12

What is a Dutcher body?

Answer 12

an invagination of the cytoplasm into the nucleus (looks sort of an intranuclear inclusion)

Question 13

What are Mott cells?

Answer 13

Similar to russell bodies - just looks like a bunch of grapes inside the cells (all collections of Ig)

Question 14

What is Rouleaux?

Answer 14

If there’s high levels of IgG in the serum, there’s less zeta potential pushing the RBCs away from each other and they start to stack on top of each other

Question 15

What’s the classic triad of MM symptoms?

Answer 15

anemia, bone pain and renal faiure

Question 16

What are the major causes of death in MM?

Answer 16

infection (because of the decrease in normal immunoglobulins)
renal failure

Question 17

What are the 4 criteria for MM diagnosis?

Answer 17

1. bone marrow with over 20% of plasma cells OR
2. plasmacytoma plus one of the following: monoclonal proteins in serum, monoclonal proetin in urine, lytic lesions
3. Usual clinial features of myeloma
4. Exclude connective tissue diseases, chronic ifnections, carcinoma, lymphoma, leukemia

Question 18

What are the three classic therapeutic agents for MM?

Answer 18

dexamethasone
melphalan
cyclophosphamide

Question 19

What are the newer therapeutic agents for MM?

Answer 19

thalidomide
lenalidomide (also antiangiogenic)
Bortezomib

Question 20

What sort of stem cell transplant is used in MM?

Answer 20

autologous peripheral blood stem cell

Question 21

What’s the prognosis for MM?

Answer 21

with conventional chemo: 3-4 years

with intensive therapy: varies - in young patients 50% with 10 year survival