Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BPT Haematology > Multiple Myeloma and Principles of Autograft > Flashcards

Multiple Myeloma and Principles of Autograft Flashcards

1
Q

What are the risk factors for progression from MGUS?

A

M protein > 15g/L, non IgG MGUS, serum FLC ratio abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the definition of MGUS?

A

M protein < 30 g/L
clonal plasma cells in BM < 10%
no myeloma defining events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the definition of smoldering myeloma?

A

M protein > 30g/L (serum) or > 500mg/24 hours (urine)
clonal plasma cells in BM 10% to 60%
no myeloma defining events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the definition of multiple myeloma?

A 
clonal BM plasma cells > 10% or > 1 biopsy proven plasmacytoma AND 1 or more MM-defining events:
> 1 CRAB feature
> 1 biomarker of malignancy:
clonal plasma cells in BM > 60%
serum FLC ratio > 100
> 1 MRI focal lesion > 5mm on MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some of the common clinical presentations for multiple myeloma?

A 
bone pain with negative bone scan
low BMD with paraprotein
normo/macrocytic anaemia with high total protein
acute renal failure with anaemia
back pain with anaemia
hyperviscosity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the clinical features of hyperviscosity?

A

confusion, headache, visual changes, mucosal haemorrhage, high output heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which immunoglobulin is most likely to cause hyperviscosity?

A

IgM > IgA > IgG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What defines stage I multiple myeloma?

A

beta 2 microglobulin < 3.5
albumin > 35
no high risk cytogenetics
normal LDH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What defines stage II multiple myeloma?

A

beta 2 microgobulin between 3.5 and 5.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What defines stage III multiple myeloma?

A

beta 2 microglobulin > 5.5

high risk cytogenetics or elevated LDH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the high risk cytogenetic features?

A 
17p deletion
translocation (14;16)
translocation (16;20)
translocation (4;14)
1q addition
1p deletion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What investigations are required for workup of a myeloma patient?

A 
FBE and film
UEC
CMP
SPEP, immunofixation
quantification of serum Igs
urinalysis, 24 hr UPEP and immunofixation
BM aspirate and/or biopsy
cytogenetics
serum beta 2 microglobulin
LDH
serum free light chains
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the findings of FBE, UEC, CMP, protein and albumin in multiple myeloma?

A 
normocytic anaemia
cytopaenias
hypercalcaemia
elevated creatinine
elevated protein
low albumin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the findings on a blood film in multiple myeloma?

A

rouleaux, circulating plasma cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In what benign conditions may serum free light chain levels be elevated?

A

polyclonal hypergammaglobulinaemia
renal failure
however ratio will be normal -> ratio is only abnormal in monoclonal plasma cell disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the benefit of measuring the serum free light chain ratio?

A

can detect patients who are only producing a small amount of paraprotein

17
Q

What percentage of patients with AL amyloidosis have an abnormal serum free light chain ratio?

A

98%

18
Q

In what ways does multiple myeloma cause renal impairment?

A 
myeloma cast nephropathy (most common)
light chain deposition disease
amyloidosis
acquired fanconi
hypercalcaemia
hyperuricaemia
19
Q

What is the pathophysiology of myeloma cast nephropathy?

A

paraproteins are filtered through the glomeruls
in the tubule they complex with tamm-horsfall proteins and form casts which block the tubules
endocystosed in the cell and cause a toxic inflammatory cascade (which relies heavily on NFkappaB)

20
Q

What are the morphological features of a bone marrow aspirate in multiple myeloma?

A

dutcher bodies
flame cells
russel bodies
mott cells

21
Q

What proteasome inhibitors are available in Australia for multiple myeloma treatment?

A

bortezomib

carfilzomib

22
Q

What immunomodulators are available in Australia for multiple myeloma treatment?

A

thalidomide
lenalidomide
pomalidomide

23
Q

What monoclonal antibody is available in Australia for multiple myeloma treatment?

A

daratumumab

24
Q

What is the main side effect of bortezomib and thalidomide?

A

neuropathy

25
Q

What is the main side effect of lenalidamide and pomalidomide?

A

cytopaenia

26
Q

What is the main side effect of carfilzomib?

A

cardiac problems

27
Q

What is the current induction therapy for both transplant eligibile and ineligible multiple myeloma patients?

A

bortezomib, lenalidomide and dexamethasone triple therapy

28
Q

What did the results of the MMXI trial show?

A

that giving patients lenalidomide rather than observing them after transplantation prolongs remission

BPT Haematology (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions