multiple myeloma

Question 1

what is this blood film

Answer 1

multiple myeloma

nucleus pushed to side by golgi appartus

Question 2

investigations for MM

Answer 2

electrophoresis ( monoclonal gamma band paraprotein)

rouleaux on blood film (RBC stacking) nucleus pushed to side

bence jones protein in urine

High ESR

>10% plasma cells in BM biopsy

CT MRI pet for bone leisons

note:polyclonal gammopathy is normal infection

Question 3

MM immunopenotyping

Answer 3

CD 138 CD38 +ve Cytoplasic Ig positive (on inside cause producing Ig)

CD 20 -ve ( unlike other B cell lymphomas)

Question 4

renal failure in MM cause

Answer 4

proximal tubule necrosis nephropathy

paraprotein light chains crystalise in kidney and block them.

cast nephropathy

Question 5

treatment of MM

Answer 5

generally: steroids ‘imids’ protease inhbitors. cytostatic drugs

mustard gas nitrogen mustard-type alkylating agent

autologous haematopoietic stem cell transplanation

following cytotoxic drugs, collect stem cells then high-dose melphalan to kill myeloma cells , re-infuse stem cells to rescue blood formation.

proteasome inhibitors , plasma myeloma cells are protein secreting factories , misfolded proteins get removed by protezome. bortezomib accumulates misfolded immunoglobulins which kill the myeloma cells.

Thalidomide particularly effectove against myeloma targets transcirption factors

Question 6

which is not a characterisic myeloma characteristic

splenomegaly

abnormal electropheresis

paraproteinaemia

Answer 6

splenomegaly

Question 7

key myeloma marker

cd138

surface Ig

cd19

cd20

Answer 7

cd138

cd19 (normal b cell)

suface Ig (on inside not surface)

cd20 (similar to cd19 not on these mature plasma cells)

Question 8

myeloma cells have well developed

nucleus

mitochondria

er

cell membrane

Answer 8

ER for mass Ig production