MULTIPLE MYELOMA Flashcards
what type of cells are affected in myeloma
plasma cells
what type of blood cell are plasma cells
antibody-producing B lymphocytes
describe the pathophysiology of myeloma
uncontrolled replications of a single plasma cell clone results in overproduction of a specific type of immunoglobulin
what is a characteristic diagnostic finding of myeloma
monoclonal band on serum and urine electrophoresis
how does myeloma result in reduced blood counts
plasma cell clones accumulate in the bone marrow, crowding out healthy tissue responsible for making blood cells
what are paraproteins
abnormal immunoglobulin light chains
how does myeloma affect the kidney
paraproteins form casts in the thick ascending limb of the loop of henle by interacting with other proteins
these cast block the tubules
how does myeloma affect the bone structure
abnormal plasma cells secrete factors which activate osteoclasts to break down bone
what are the consequence of osteoclast activation in myeloma
lytic lesions
bone pain
hypercalcaemia
what different types of myeloma are there
IgG (most common 2/3)
IgA (1/3)
IgD and IgM (rare)
what are the most common signs and symptoms of myeloma
CRAB hyperCalcaemia Renal failure Anaemia Bone lesions
what is the most common symptoms in myeloma
bone pain
where are common areas for bone pain
spine
ribs
how are lytic lesions best visualised
plain X-ray
appear as punched out areas
what type of anaemia is associated with myeloma
normally normocytic normochromic
when do symptoms of thrombocytopenia tend to present
when platelets reach critically low levels <10
what symptoms are associated with thrombocytopaenia
petechiae
brusing
bleeding
what symptoms might present with renal failure
nausea/vomiting/weight loss/lethargy (uraemia)
pruritus/muscle cramping (phosphate)
SOB/oedema
why are patients more prone to infection
neutropenia due to ineffective haematopoiesis
reduced production of functional immunoglobulin due to monoclonal Ig overproduction
what are the most common types of infection
respiratory and urinary
what neurological symptoms can patients get and why
confusion, weakness and fatigue - Hypercalcaemia
headaches and visual disturbances - hyper viscosity
peripheral neuropathy - amyloid deposition
limb weakness and loss of bowel/bladder control - spinal cord compression
what signs are there on FBC
anaemia
neutropaenia
thrombocytopaenia
what signs might be present on U&Es
raised creatinine
Hypercalcaemia
what effect does myeloma have on the ESR
persistently raised
what features may be seen on blood film
rouleaux (red cells stacked on top of each other)
what might electrophoresis of the blood and urine show
Bence Jones proteins (paraproteins)
what are free light chain levels useful for
assessing response to treatment
can identify relapse of disease before onset of symptoms
what imagine should be done
skeletal survey
X-rays of skull, axial skeleton and proximal long bones
how does bone marrow biopsy aid diagnosis
assess percentage of bone marrow occupied by plasma cells
how are plasma cells identified
immunohistochemistry
why can cryogenics help decide treatment
treatment can be targeted to specific mutations
what are the three distinct diagnoses within the myeloma spectrum of disease
symptomatic myeloma
asymptomatic myelome
monoclonal gammopathy of undetermined significance
what are the criteria for a diagnosis of symptomatic myeloma
clonal plasma cells >10% on bone marrow biopsy or in a biopsy from other tissues
a monoclonal protein (paraprotein) in either serum or urine)
evidence of end-organ damage felt related to the plasma cell disorder
how is asymptomatic myeloma different to symptomatic myeloma
no end-organ damage
what are the criteria for a diagnosis of asymptomatic myeloma
serum paraprotein >30 g/L
+/- clonal plasma cells >10% on bone marrow biopsy
NO myeloma related organ or tissue impairment
what are the criteria for a diagnosis of MGUS
serum paraprotein <30 g/L
clonal plasma cells <10% on bone marrow biopsy
NO myeloma related organ or tissue impairment
what is the initial treatment for patients under 65
stem cell transplantation
what are the steps on autologous stem cell transplantation
extraction of a patients stem cells
course of chemotherapy
return stem cells to patient
what are the steps in allogenic stem cell transplantation
course of chemotherapy
given donor stem cells
what are the pros and cons of allogeneic stem cell transplantation
pros: potential of a cure
cons: greater mortality rate
initial treatment for patients >65/with significant concurrent illness
chemotherapy alone
what happens in the event of resistance to treatment
try a different agent
what is the media survival with high dose chemo and autologous stem cell transplantation
4.5 years
