MULTIPLE MYELOMA

Question 1

what type of cells are affected in myeloma

Answer 1

plasma cells

Question 2

what type of blood cell are plasma cells

Answer 2

antibody-producing B lymphocytes

Question 3

describe the pathophysiology of myeloma

Answer 3

uncontrolled replications of a single plasma cell clone results in overproduction of a specific type of immunoglobulin

Question 4

what is a characteristic diagnostic finding of myeloma

Answer 4

monoclonal band on serum and urine electrophoresis

Question 5

how does myeloma result in reduced blood counts

Answer 5

plasma cell clones accumulate in the bone marrow, crowding out healthy tissue responsible for making blood cells

Question 6

what are paraproteins

Answer 6

abnormal immunoglobulin light chains

Question 7

how does myeloma affect the kidney

Answer 7

paraproteins form casts in the thick ascending limb of the loop of henle by interacting with other proteins
these cast block the tubules

Question 8

how does myeloma affect the bone structure

Answer 8

abnormal plasma cells secrete factors which activate osteoclasts to break down bone

Question 9

what are the consequence of osteoclast activation in myeloma

Answer 9

lytic lesions
bone pain
hypercalcaemia

Question 10

what different types of myeloma are there

Answer 10

IgG (most common 2/3)
IgA (1/3)
IgD and IgM (rare)

Question 11

what are the most common signs and symptoms of myeloma

Answer 11

CRAB
hyperCalcaemia 
Renal failure 
Anaemia 
Bone lesions

Question 12

what is the most common symptoms in myeloma

Answer 12

bone pain

Question 13

where are common areas for bone pain

Answer 13

spine

ribs

Question 14

how are lytic lesions best visualised

Answer 14

plain X-ray

appear as punched out areas

Question 15

what type of anaemia is associated with myeloma

Answer 15

normally normocytic normochromic

Question 16

when do symptoms of thrombocytopenia tend to present

Answer 16

when platelets reach critically low levels <10

Question 17

what symptoms are associated with thrombocytopaenia

Answer 17

petechiae
brusing
bleeding

Question 18

what symptoms might present with renal failure

Answer 18

nausea/vomiting/weight loss/lethargy (uraemia)
pruritus/muscle cramping (phosphate)
SOB/oedema

Question 19

why are patients more prone to infection

Answer 19

neutropenia due to ineffective haematopoiesis

reduced production of functional immunoglobulin due to monoclonal Ig overproduction

Question 20

what are the most common types of infection

Answer 20

respiratory and urinary

Question 21

what neurological symptoms can patients get and why

Answer 21

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

Question 22

what signs are there on FBC

Answer 22

anaemia
neutropaenia
thrombocytopaenia

Question 23

what signs might be present on U&Es

Answer 23

raised creatinine

Hypercalcaemia

Question 24

what effect does myeloma have on the ESR

Answer 24

persistently raised

Question 25

what features may be seen on blood film

Answer 25

rouleaux (red cells stacked on top of each other)

Question 26

what might electrophoresis of the blood and urine show

Answer 26

Bence Jones proteins (paraproteins)

Question 27

what are free light chain levels useful for

Answer 27

assessing response to treatment

can identify relapse of disease before onset of symptoms

Question 28

what imagine should be done

Answer 28

skeletal survey

X-rays of skull, axial skeleton and proximal long bones

Question 29

how does bone marrow biopsy aid diagnosis

Answer 29

assess percentage of bone marrow occupied by plasma cells

Question 30

how are plasma cells identified

Answer 30

immunohistochemistry

Question 31

why can cryogenics help decide treatment

Answer 31

treatment can be targeted to specific mutations

Question 32

what are the three distinct diagnoses within the myeloma spectrum of disease

Answer 32

symptomatic myeloma
asymptomatic myelome
monoclonal gammopathy of undetermined significance

Question 33

what are the criteria for a diagnosis of symptomatic myeloma

Answer 33

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

Question 34

how is asymptomatic myeloma different to symptomatic myeloma

Answer 34

no end-organ damage

Question 35

what are the criteria for a diagnosis of asymptomatic myeloma

Answer 35

serum paraprotein >30 g/L

+/- clonal plasma cells >10% on bone marrow biopsy

NO myeloma related organ or tissue impairment

Question 36

what are the criteria for a diagnosis of MGUS

Answer 36

serum paraprotein <30 g/L

clonal plasma cells <10% on bone marrow biopsy

NO myeloma related organ or tissue impairment

Question 37

what is the initial treatment for patients under 65

Answer 37

stem cell transplantation

Question 38

what are the steps on autologous stem cell transplantation

Answer 38

extraction of a patients stem cells

course of chemotherapy

return stem cells to patient

Question 39

what are the steps in allogenic stem cell transplantation

Answer 39

course of chemotherapy

given donor stem cells

Question 40

what are the pros and cons of allogeneic stem cell transplantation

Answer 40

pros: potential of a cure
cons: greater mortality rate

Question 41

initial treatment for patients >65/with significant concurrent illness

Answer 41

chemotherapy alone

Question 42

what happens in the event of resistance to treatment

Answer 42

try a different agent

Question 43

what is the media survival with high dose chemo and autologous stem cell transplantation

Answer 43

4.5 years