Multiple Myeloma Flashcards

1
Q

what is multiple myeloma characterized by

A

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)

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2
Q

examples of the extensive skeletal destruction caused by plasma cells proliferating in the bone marrow

A
osteolytic lesions
osteopenia
pathologic fractures
bone pain
hypercalcemia
anemia
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3
Q

median age to present with multiple myeloma

A

70

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4
Q

who is more likely to get multiple myeloma

A

occurs in all races
blacks 2x higher than whites
3.7x more likely to get if 1st degree relative with MM

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5
Q

clinical presentation of multiple myeloma

A
normocytic anemia
bone pain
elevated creatinine
fatigue/general weakness
hypercalcemia
weight loss
paresthesis
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6
Q

how many people with multiple myeloma are asymptomatic

A

up to 1/3

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7
Q

initial testing for multiple myeloma

A
CBC with diff
serum chemistries (Ca, Cr, BUN, albumin)
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8
Q

confirmatory testing for multiple myeloma

A
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
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9
Q

testing with oncology consult for multiple myeloma

A
bone marrow aspirate and biopsy
BM cytogenetics
flow cytometry
FISH
immunohistochemistry
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10
Q

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

A

gamma region

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11
Q

key test in diagnosis of MM

A

bone marrow aspirate and biopsy

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12
Q

what two criteria must be met to diagnose MM

A

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)

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13
Q

what are the myeloma-defining events

A

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

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14
Q

plasma cell proliferative disorder (CRAB)

A

hyperCalcemia
Renal insufficiency
Anemia
Bone lesions: one or more lytic lesions

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15
Q

treatment if not a transplant candidate

A

chemotherapy

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16
Q

treatment if a transplant candidate

A

myeloablative chemotherapy

autologous stem cell transplant then consolidation and maintenance chemotherapy

17
Q

treatment of bone disease

A

IV zoledronic acid (Recast)
pamidronate
calcium and vit D supplements

18
Q

treatment of thromboembolic events

A

thromboprophylaxis: heparin or warfarin

19
Q

treatment of infection

A

prophylactic antibiotics

20
Q

what is MGUS (monoclonal gammopathy of undetermined significance)

A

clinically asymptomatic premalignant clonal plasma cell or lymphoplasmacytic proliferative disorder
serum monoclonal protein M less than 3 gm/dL, bone marrow with less than 10% monoclonal plasma cells, and NO CRAB

21
Q

why should patients with MGUS be monitored

A

associated with small risk of progressing to malignant plasma cell dyscrasia or lymphoproliferative disorder