Multiple Myeloma

Question 1

what is a myeloma

Answer 1

Bone marrow cancer with a monoclonal
proliferation of plasma cell

• the uncontrollable reproduction of plasma cells.
• produces antibodies in excess.

Question 2

causes of polyclonal gammopathies

Answer 2

multiple different immunoglobulins being produced. Often because polasma cells are responding to insult.

1. infection
2. rheumatologic diseases
3. vasculitis
4. liver diseases
5. non-hematological cancers
6. others.

Question 3

2 main causes of monoclonal gammopathies

Answer 3

Question 4

Different types of Heavy, Ligth and variable protein Myeloma

Answer 4

Question 6

different types of tests to run for secretory vs light chain myeloma

Answer 6

seceretory– biochemistry in blood

light chain – urine test. if you don’t do it you might miss light chain

there are some non-secretory myelomas with no protein detection.

Question 7

common complications of MM

Answer 7

malignant proliferation of Plasma cells can lead to

1. skeletal destruction
2. marrow infiltration
3. monoclonal protein cause hyperviscosity and renal failyre
4. reduction of normla immune globulins

Question 8

Answer 8

tons of plasma cells

Question 9

what red cell formation may you see in someone with MM

Answer 9

rouleaux formation may be an indicator that there are increased MONOCLONAL Igs in the blood.

Question 10

specific cytogenetic findings that are expressed in MM cells

Answer 10

CD138 that might cause light chain restriction (kappa or lambda)

translocation 14 also can indicate worse MM

Question 11

review tests:

Question 12

supportive measures for MM: symptom control

Answer 12

pain control (experiencing bone pain)

vertebral kyphoplasty

hydration

antibiotics

radiation therapy

Question 13

preventative measures for MM (preventing it from getting worse)

Answer 13

• bisphosphonates
• pamidronate
• intravenous immunoglobulins

Question 14

8 classes of treatment -specific therapies for MM

Answer 14

1. Steroids
2. alkylators
3. anthrcyclins
4. proteosome inhibotrs
5. immunomodulatory agents (thalidomide)
6. monoclonal antibodies
7. histone deacetylase inhibitors
8. others.

Question 16

at what stage do you treat MM?

Answer 16

at symptomatic myeloma. there is a part of the natural history called SMOLDERING/ASYMPTOMATIC MYELOMA that might be coincidentally found but it has no been determined that early treatment helps.

Question 17

how to tell between symptomatic myeloma or mgus (monoclonal gammopathy of undetermined significance/non-symptomatic)/

Answer 17

symptomatic myeloma will have CRAB symptoms

Question 18

mechanism of amyloidosis

Answer 18

amyloidosis is a clincal syndrome caused by organ deposition of abnormla, insoluble portein in beta pleated sheets. It is often due to an irregular lambda light chain, and can be found concurrentyl with MM.

Almost any organ can be involved in amyloidosis. amyloid plaques can built in the liver, heart, kidney, nerves, skin, GI tract etx.

Question 19

Answer 19

amyloid plaques.

Question 20

T/F amyloidosis is curable

Answer 20

false. treatment is supportive cause and with the same agents as myeloma for AL amyloid.

Question 21

Waldenstrom’s Macroglobulinemia is a type of ____ where lymphadenopathy and splenomegaly are common. This is a disease of the ___ protein (often large). It is incurable and can cause ____ of the blood.

Answer 21

Waldenstrom’s Macroglobulinemia is a type of LYMPHOMA where lymphadenopathy and splenomegaly are common. This is a disease of the MONOCLONAL IGM protein (often large). It is incurable and can cause HYPERVISCOSITY of the blood, which causes blurry vision, headaches, SOB, ischemic events.

Question 22

overall, monoclonal gammopathy suggests malignancy. Monoclonal proteins may be seen with plasma cell ____ (myeloma) and lymphoproliferative diseases (____)