Multiple Myeloma (Haematology 3) Flashcards
Where can you detect monoclonal proteins released by myeloma cells?
Blood
Urine
How does MM develop?
Genetic mutation causes damage to B cell lymphocyte
This malignant immature B cell produces malignant plasma cells (myeloma cell)
What is MM?
Cancer of the plasma cells in bone marrow
Where do myeloma cells accumulate?
Bone marrow and blood
What does microevironment of MM cell consist of?
- osteoclasts and osteoblasts
- clonal myeloma cells
- bone marrow stromal cells
- extracellular matrix proteins
What does microenvironmetn do?
Protects Myeloma cells from apoptotic stimuli (e.g. chemotherapy) hence confer resistance to treatment
Which inflammatory cytokines released in MM?
IL-6
TNF-alpha
IGF-1 (insulin like growth)
VEGF
Which is the most common Ig associated with MM?
IgG
Main clinical presentations of MM?
Anaemia
Bone disease
Hypercalcaemia
Renal impairment
Infection
Hyperviscosity syndrome
Why do you get bone disease/issues with MM?
RANKL overexpressed in stromal bone marrow
Activating osteoclasts to stimulate bone resorption
Causing bone pain/fracture
Name the 4 criteria for diagnosis of MM
THINK: CRAB
Calcium high
Renal Insufficiency
Anaemia
Bone disease
What makes a patient ineligible for transplant tx?
Frailty index
Age
Renal impairment
Why give bisphosphonates as supportive therapy?
Inhibits bone resorption by inhibiting osteoclast activity
hence reducing bone lesions
Which bisphosphonate do you use in MM?
Zolendronic acid
Induction regimen for NON transplant eligible patients
Thalidomide OR Bortezomib
+ Alkylating agent
+ Dexamethasone
