Multiple Myeloma Flashcards
The first 11 cards will be from the “I’d like you to know” slide.
Nailed it.
What is an M spike?
Large spike on serum electrophoresis that indicates the presence of monoclonal proteins.
What does immunofixation electrophoresis (IFE) tell you?
IFE follows SPEP. IFE will tell you what type of Ig the monoclonal Ab is.
Name the four components of CRAB.
C- hyperCalcemia
R- Renal insufficiency
A- Anemia
B- Bone destruction
Describe the mechanism of bone destruction in myeloma.
Myeloma cells produce DKK1 leading to increase in RANKL and IL-6 by osteoblast progenitor cells and marrow stromal cells. Osteoblast differentiation is blocked and osteoclast maturation is stimulated.
Stage a myeloma with Durie Salmon.
Stage I- Hb>10, Ca normal or 12, multiple lytic lesions, high M protein w/ IgG>7 or IgA>5, Bence Jones>12g/24hr
Stage a myeloma with ISS.
Stage I- B2m3.5
Stage II- B2m5.5
Name the worst prognostic chromosome abnormality in myeloma.
del(17p)
What 2 classifications of new drugs have changed the way we treat myeloma? MOA?
- Immunomodulatory Drugs: Thalidomide/Lenalidomide MOA=act via cytokine effects (I think)
- Proteosome Inhibitors: Bortezomib MOA=inhibits 26S proteasome disrupting cellular homeostasis and causing cell death
When is an autologous transplant indicated in myeloma?
Patients <70 yo and in otherwise good health
Why do Waldenstrom pt’s become hyperviscous more commonly than myeloma pt’s?
IgM is a much bigger molecule
Name 3 causes of amyloidosis.
Deposition of the 3 following amyloid proteins:
- Light Chain (secondary to myeloma)
- Transthyretin (familial)
- AA (derived from serum amyloid A; osteomyelitis)
That’s the end of “I’d like you to know” slides.
It’s been real.
Define multiple myeloma.
A malignancy of late B cells that mature principally into neoplastic plasma cells that generally produce a complete and/or partial (light chain) monoclonal immunoglobulin protein.
Blood smear of myeloma shows what?
Roleaux of red cells
SPEP and IFE show what in myeloma?
SPEP: M-spike
IFE: type of monoclonal Ig being produced
What 3 things are required for the dx of myeloma?
- M-protein in serum or urine
- Marrow clonal plasma cells or plasmacytoma
- Related organ or tissue impairment
What are the 7 complications of myeloma (includes CRAB)?
- Bone destruction
- Hypercalcemia
- Renal insufficiency
- Hypogammaglobulinemia
- Anemia
- Amyloidosis
- Hyperviscosity
Bone destruction is manifested how clinically?
Pain. Fractures. Spinal cord compression.
Hypercalcemia is manifested how clinically?
Altered mental status. Renal insufficiency.
What can cause the renal insufficiency seen in myeloma?
Light chain nephropathy, amyloid, uric acid, hypercalcemia, infection.
Describe MGUS.
Common in elderly. M protein present but other multiple myeloma features absent. Other Ig’s normal. Less likely to have Bence Jones proteinuria. Rate of progression to monoclonal B cell malignancy is 1% per year.
Describe smoldering myeloma.
In between form of multiple myeloma. Asymptomatic. Serum M protein > 3g/dL OR BM plasma cells >10%. No CRAB.
Is treatment recommended for MGUS and smoldering myeloma?
No. Both diseases are mostly asymptomatic so it is best just to observe and monitor.
