Multiple Myeloma Flashcards
Bone marrow for multiple myeloma?
At high power - weird looking cells. Plasma cells are bigger and eccentric in shape. Nucleus off to side.
Definitions/things to know about MM
Monoclonal plasma cell proliferation
Monoclonal gammopathy
Decreased normal immunoglobins
Osteolytic lesions
Does MM go to blood?
No, tends to stay in marrow
What is an M-spike?
an increase in monoclonal immunoglobin
Most common Ig in M spike?
IgG, followed by IgA
Rarely IgD or IgE
Never IgM
What is Bence Jones protein?
light chain Ig in urine
Morphology of blood in Multiple Myeloma?
Anemia, rouleaux
Morphology of marrow in MM?
plasma cells, amyloid
hypercellular, monotonous, not a lot of fat
What is a Russell Body?
cell making Ig but the Ig cannot get out
Lots of Russell bodies - Mott Cell
Dutcher body?
invagination of cytoplasm in the plasma cell
What association with Rouleaux?
Multiple myeloma (duh)
What is amyloid?
Light chains that collect and make a conformation that is stuck together
Waldenstrom macroglobulinemia?
IgM, Lymphoplasmacytoid lymphoma
Hyperviscosity (IgM so big, makes blood sludgy)
Symptoms of Waldenstrom macroglobulinemia?
Retinal changes
Neurological changes
MGUS (Monclonal gammopathy of Undetermined Significance)
Small m spike with no myeloma symptoms
Does MGUS mean Myeloma?
occasionally MGUS will turn into Myeloma
Relation of angiogenesis and myeloma?
Increased production of growth factors which stimulate angiogenesis and plasma cell development
Upregulation
80% of people with MM present with what?
Bone pain (low back, pelvis and ribs) Associated with multiple lytic bone lesions (increased osteoclast activity)
What is the cause of bruising/bleeding in MM?
decreased platelets
What is the cause of infections in MM?
decrease levels of normal Ig
What is the cause of hypercalcemia in MM?
Bone destruction
50% of patients with MM present with?
Renal failure
What is hyperviscosity syndrome?
large amounts of circulating Ig cause purpura, confusion and decreased vision
Major causes of death in MM?
Infection and Renal failure
Classic Triad of MM?
Anemia, Bone Pain, Renal Failure
Is MM curable?
No, but it is treatable
Classic agents for MM
Dexamethasone (steroid)
Melphalan - alkylating agent
Cyclophosphamide - alkylating agent
Problem with PBSC
Contamination of the autologous graft by the myeloma cells
Newer agents of MM
Thalidomide
Lenalidomide
Bortezomib
