Multiple Myeloma Flashcards
What is multiple myeloma?
- cancer of plasma cells
- plasma cells typically produce antibodies and pay key role in immune immune function
- overgrowth of abnormal plasma cells –> m-protein (MONOCLONAL)
multiple myeloma - etiology:
- more men than women
- more AA than white
- avg age of 65
heavy chains are on what chromosome?
14 - IgG, IgA, IgM, IgD, IgE
which heavy chain will you see most often? second most often?
IgG
IgA
Light chain can be?
lambda or kappa
MGUS vs myeloma:
-monoclonal gammopathy of und significance
- precancerous condition
- no symptoms
- 1% chance per year to develop myeloma
symptoms of myeloma:
- bone pain/fractures (lytic)
- numbness/tingling in lower back/legs
- weight loss
- weakness (anemia), N/V, altered mental status (Could be hypercalcemia)
- short of breath
- urinary issues
criteria to diagnose multiple myeloma
1) presence of a serum or urinary monoclonal protein (some combo of heavy and light chain)
2) presence of clonal plasma cells in the bone marrow or a plasmacytoma
3) presence of end organ damage felt related to the plasma cell dyscrasia (such as increases Ca, lytic bone lesions, anemia, or renal failure)
criteria to diagnose smoldering (asymptomatic) mutliple myeloma:
1) serum monoclonal proteins >=3g/dL and or >=10% to <60% of bone marrow clonal plasma cells
2) no end organ damage related to plasma cell dyscrasia
criteria to diagnose MGUS:
1) serum monoclonal protein <10%
3) no end organ damage related to plasma cell dyscrasia or a related b-cell lymphoprotliferative disorder
INternational staging system:
stage 1: Beta2M=3.5
stage 2: neither stage 1 or 3
stage 3: B2M>=5.5
best survival with which stage multiple myeloma?
stage 1
your genetics relating to the disease determine your?
risk –> determines your treatment
depends mostly on chromosmoe 14 being involved (heavy chain)
treatment is based on?
RISK
high risk patient,w hat is important part with treatment?
at least 4 months of tx and then think transplant
most remission seen with what kind of transplant?
autologous!
Do you continue with maintenance therapy
high risk?
- YES with high risk
plasmacytoma what is it?
focused area of plasma cells in the bone or other area (extramedullary)
most likely area for a plasmacytoma?
humerous most
femus
pelvis
vertebra least
criteria for plasmacytoma
- all patients will have either no or low levels of M-protein in serum or urine
- serum Ig levels are usually preserved
- serum free light chains may be elevated
extramedullary sites for plasmacytoma?
most common site?
-URT - MOST COMMON GI, CNS bladder thyroid breasts testes parathyroid LN
extramedullary plasmacytomas
-location is…? good thing about this?
more localized and more curable with localized radiotherapy and/or can be removed
Diagnosis-plasmacytoma
- **-serum or urine M protein can be present in low level
- biopsy proven solitary lesion of bone or soft tissue with evidence of clonal plasma cells
- normal skeletal survey and MRI of spine and pelvis
- absence of end organ damage that can be attributed to a plasa cell disorder
- bone marrow with no evidence of plasma cells
-SHOULD NOT HAVE END ORGAN DAMAGE
plasmacytoma treatment:
- radiation therapy for bone or ST
- extramedullary plasmacytomas can be surgically removed
