Multiple myeloma

Question 1

what is the abnormal protein produced in multiple myeloma?

Answer 1

M protein

Question 2

what is the most common heavy chain proliferation in multiple myeloma?

Answer 2

IgG

Question 3

what are the symptoms of myeloma?

Answer 3

1. lytic bone lesions

2. numbness / tingling in lower back / legs

Question 4

what test is required to view the lytic bone lesions of multiple myeloma?

Answer 4

bone survey

Question 5

what are the criteria for multiple myeloma diagnosis?

Answer 5

1. serum / urine monoclonal protein
2. clonal plasma cells in bone marrow
3. end organ damage

Question 6

how is smoldering myeloma different from multiple myeloma?

Answer 6

no end organ damage

Question 7

how is smoldering myeloma different from MGUS?

Answer 7

for smoldering serum monoclonal protein is greater than 3 g/dL and 10-60% bone marrow clonal plasma cells

Question 8

what is the mainstay therapy for myelomas?

Answer 8

steroids

Question 9

what is the overall goal of stem cell transplant therapy?

Answer 9

remission

Question 10

where are plasmacytomas located?

Answer 10

isolated myeloma mass in bone, most commonly humerus

Question 11

what is the most common site for extramedullary plasmacytoma?

Answer 11

upper respiratory tract

Question 12

what are the diagnostic criteria for plasmacytoma?

Answer 12

1. biopsy proven solitary lesion of bone or soft tissue with evidence of clonal plasma cells
2. bone survey
3. absence of end organ damage

Question 13

what is the treatment for plasmacytoma?

Answer 13

1. radiation for bone or soft tissue

2. surgery and/or radiation for extramedullary

Question 14

definition: amyloidosis

Answer 14

protein conformation disorder associated with clonal plasma cell dyscrasia

Question 15

what is the clinical feature of amyloidosis?

Answer 15

extracellular deposition of light chain fragments in an abnormal insoluble fibril form

Question 16

what % of patients with myeloma have concurrent amyloidosis?

Answer 16

10%

Question 17

what is the diagnosis for amyloidosis?

Answer 17

definitive - congo red stain

Question 18

what are the screening tests for amyloidosis?

Answer 18

1. electrophoresis and urine IF

2. serum free light chains

Question 19

what is the most important factor for prognosis of amyloidosis?

Answer 19

cardiac involvement

Question 20

what is the treatment goal for amyloidosis?

Answer 20

retardation of further damage

Question 21

what are the clinical features of waldenstroms macroglobulinemia?

Answer 21

1. excess IgM in blood

2. lymphoplasmacytic lymphoma in marrow

Question 22

what is the main symptom associated with waldenstroms macroglobulinemia?

Answer 22

hyperviscosity

Question 23

what is the diagnosis for waldenstroms?

Answer 23

1. IgM monoclonal gammopathy (any size)

2. over 10% monoclonal lymphocytes and plasma cell differentiation in bone marrow

Question 24

what are the treatments for symptomatic waldenstroms?

Answer 24

chemo, plasmapheresis