Multiple Myeloma Flashcards
The median age at diagnosis of multiple myeloma is: A. 39 B. 49 C. 59 D. 69 E. 79
D. 69
True or False: MM affects men slightly more than women, and African American have twice the incidence and mortality as Caucasians.
True
Which type of cells does multiple myeloma affect?
Terminally differentiated B cells (plasma cells)
Interleukin-\_\_ (IL-\_\_) is a growth factor that promotes the survival of the Multiple Myeloma cell. A. 2 B. 3 C. 4 D. 5 E. 6
E. 6
Multiple myeloma cells secrete IL-__, IL-___, and the soluble IL-6 receptor that activate osteoclasts in the vicinity of the myeloma cell to cause bone resorption
IL-1 and IL-6
True or False: Patients with Multiple Myeloma present with an increase in blood vessel density, with elevated basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF).
True
In the model of disease progression for multiple myeloma, which of the following is the correct order?
A. Multiple myeloma, smoldering myeloma, normal plasma cell, monoclonal gammopathy of undetermined significance (MGUS)
B. Normal plasma cell, smoldering myeloma, MGUS, multiple myeloma
C. Normal plasma cell, MGUS, multiple myeloma, smoldering myeloma
D. Normal plasma cell, MGUS, smoldering myeloma, multiple myeloma
D. Normal plasma cell, MGUS, smoldering myeloma, multiple myeloma
True or False: Early initiation of chemotherapy in the MGUS and smoldering myeloma stages has been shown to improve outcomes.
False! It did not improve outcomes, so observe patient and begin treatment when symptomatic.
True or False: With multiple myeloma, there is increased bone resorption.
True
The easy way to remember how multiple myeloma patients present is by using the acronym CRAB. What does each letter stand for?
C = Increased calcium above 11.5 R = Renal function decrease (Scr > 2) A = Anemia (hemoglobin < 10 or 2 g below lower limit of normal) B = Lytic bone lesions
________ are plasma cell tumors that arise outside the bone marrow in multiple myeloma.
Extramedullary plasmacytomas (EMPs)
_______ is the most common site that extramedullary plasmacytomas (EMPs) in multiple myeloma occur, but may present in any organ.
Upper Respiratory Tract
Of the initial workup for multiple myeloma, all of the following are extremely important and should be focused on EXCEPT:
A. Skeletal survey
B. Bone marrow aspirate/biopsy
C. Serum protein electrophoresis (SPEP)
D. 24-hr urine for urine protein electrophoresis (UPEP)
A. Skeletal survey (this is also a test that can be done, but she said to focus on the other 3).
Which of the following types of multiple myeloma is the most common?
A. Heavy chain (IgG, IgA, IgM)
B. Light chain (Kappa or lambda)
C. Non-secretory
A. Heavy chain (IgG, IgA, IgM)
Which of the following types of multiple myeloma has no detectable immunoglobulin?
A. Heavy chain (IgG, IgA, IgM)
B. Light chain (Kappa or lambda)
C. Non-secretory
C. Non-secretory
Patients with which of the following types of multiple myeloma are at higher risk for hyperviscosity?
A. Heavy chain (IgG, IgA, IgM)
B. Light chain (Kappa or lambda)
C. Non-secretory
B. Light chain (Kappa or lambda)
~ 20% of patients with MM produce light chains only, which are incomplete immunoglobulins. Light chain proteins can cause ______ proteinuria, which is when they are secreted in the urine and cause kidney damage as well.
Bence jones
The serum protein electrophoresis (SPEP) is used in diagnosing multiple myeloma patients by assessing for a sharp peak of the gamma region called the ______.
M Spike
True or False: Smoldering myeloma patients are often symptomatic, which is why we must start chemotherapy at that stage.
False!! Smoldering myeloma is asymptomatic so only observe patients until they become symptomatic with active myeloma.
The M protein level for MGUS stage should be < __ g/dL
3
Describe how each stage of multiple myeloma presents in terms of level of M protein, % of plasma cells, and symptomatic or asymptomatic stage.
MGUS = Asymptomatic, < 10% PC, M-protein < 3 g/dL
Smoldering myeloma = Asymptomatic, M-protein ≥ 3 g/dL, and ≥ 10% PC
Active Multiple Myeloma = Symptomatic (CRAB) + M spike + ≥ 10% PC
True or False: Multiple myeloma is NOT curable.
True
True or False: Lenalidomide treatment may need to be adjusted for renal dysfunction.
True
With lenalidomide treatment for multiple myeloma, a decrease in CD34+ cells collected after prolonged lenalidomide treatment has been reported. Therefore, have stem cells collectedwithin the first __ cycles of therapy, if deemed transplant-eligible
4
List some of the common adverse effects of lenalidomide.
Peripheral neuropathy Neutropenia Thrombocytopenia Thromboembolic clots Fatigue
True or False: Bortezomib dose has to be adjusted in patients with renal dysfunction.
False! It has to be adjusted in patients with hepatic dysfunction.
Which should be used in combination therapy for multiple myeloma: low-dose dexamethasone OR high-dose dexamethasone?
Low-dose dexamethasone
Which of the following is the WORST side effect seen with the protease inhibitor bortezomib? A. Peripheral neuropathy B. Hypotension C. Fatigue D. Myelosuppression
A. Peripheral neuropathy
Which of the following formulations of bortezomib was shown to have lower peripheral neuropathy risk: IV OR subcutaneous
Subcutaneous
List some factors that would make someone NOT a candidate for transplantation in multiple myeloma.
Age > 77 years old
Direct bili > 2.0
ECOG 3 or 4
NYHA class 3 or 4
_____ can cause herpes zoster reactivation.
A. Proteasome inhibitors (bortezomib, carfilzomib, ixazomib)
B. Anti-CD20 monoclonal antibody (Rituximab)
C. Immunomodulatory agents (Thalidomide, Lenalidomide, Pomalidomide)
D. All of the above
A. Proteasome inhibitors (bortezomib, carfilzomib, ixazomib)
For transplant eligible multiple myeloma patients, there are 3 preferred 3-drug regimens. List them.
Bortezomib + lenalidomide + dexamethasone
Bortezomib + doxorubicin + dexamethasone
Bortezomib + cyclophosphamide + dexamethasone
For transplant eligible multiple myeloma patients, if the patient cannot tolerate a 3-drug regimen, what is an appropriate 2 drug regimen?
Bortezomib + dexamethasone
When comparing high dose vs. low dose dexamethasone in multiple myeloma patients, what were 3 common adverse effects seen more frequently in patients on high dose vs. low dose?
A. DVT, infections, hepatitis B reactivation
B. Infections, fatigue, hand foot syndrome
C. Fatigue, leukocytosis, DVT
D. DVT, infections, fatigue
E. Infections, leukocytosis, DVT
D. DVT, infections, fatigue
Which of the following class of medications used for multiple myeloma requires enrollment in REMS program? A. Alkylating agents B. Proteasome Inhibitors C. Steroids D. Immunomodulatory agents E. Monoclonal antibodies
D. Immunomodulatory agents (due to embryo-fetal toxicity observed with thalidomide after it being used as a N/V agent in pregnant woman decades ago).
True or False: Bortezomib IV has more efficacy compared to Bortezomib SQ.
False! They have equal efficacy with SQ having less adverse effects.
True or False: In multiple myeloma cells, the combination of lenalidomide and dexamethasone synergizes the inhibition of cell proliferation and the induction of apoptosis.
True
_________ is now the preferred immunomodulatory agent in triple drug regimens due to improved safety profile seen in multiple studies.
A. Thalidomide
B. Lenalidomide
C. Pomalidomide
B. Lenalidomide
