Multiple Myeloma Flashcards
what is multiple myeloma characterized by
neoplastic proliferation of plasma cells that produce an abnormal monoclonal immunoglobulin or light chain kappa or lambda (IgG, IgM, IgA…and rarely IgD or IgE)
examples of the extensive skeletal destruction caused by plasma cells proliferating in the bone marrow
osteolytic lesions osteopenia pathologic fractures bone pain hypercalcemia anemia
median age to present with multiple myeloma
70
who is more likely to get multiple myeloma
occurs in all races
blacks 2x higher than whites
3.7x more likely to get if 1st degree relative with MM
clinical presentation of multiple myeloma
normocytic anemia bone pain elevated creatinine fatigue/general weakness hypercalcemia weight loss paresthesis
how many people with multiple myeloma are asymptomatic
up to 1/3
initial testing for multiple myeloma
CBC with diff serum chemistries (Ca, Cr, BUN, albumin)
confirmatory testing for multiple myeloma
24 hr urine protein beta 2 microglobulin LDH serum free light chain assay serum protein electrophoresis urine protein electrophoresis serum immunofixation electrophoresis quantitative immunoglobulins skeletal survey
testing with oncology consult for multiple myeloma
bone marrow aspirate and biopsy BM cytogenetics flow cytometry FISH immunohistochemistry
97% of patients with MM will have a monoclonal (M) protein produced and secreted by the malignant plasma cells…this M protein spike is detected on what region on electrophoresis
gamma region
key test in diagnosis of MM
bone marrow aspirate and biopsy
what two criteria must be met to diagnose MM
clonal bone marrow plasma cells greater than or equal to 10% or biopsy proven extra medullary plasmacytoma AND one or more myeloma-defining events (listed on diff flashcard)
what are the myeloma-defining events
evidence of end organ damage attributed to underlying plasma cell proliferative disorder (listed on diff flashcard)
clonal bone marrow plasma cells greater than or equal to 60%
serum free light chain ratio greater than or equal to 100
more than one focal lesion on MRI studies
plasma cell proliferative disorder (CRAB)
hyperCalcemia
Renal insufficiency
Anemia
Bone lesions: one or more lytic lesions
treatment if not a transplant candidate
chemotherapy