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IHO Week 4 > Multiple Myeloma - Krafts/Johns > Flashcards

Multiple Myeloma - Krafts/Johns Flashcards

1
Q

What are the key characteristics of Multiple Myeloma?

A

Monoclonal plasma cell proliferation with monoclonal gammopathy
Osteolytic Lesions

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2
Q

What are the laboratory findings of Multiple Myeloma?

A

M-Spike
IgG in 60% of cases; IgA in 20% of cases
Bence-Jones protein in urine
Decreased normal immunoglobulins

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3
Q

What cells produce the monoclonal band of immunoglobulin?

A

Plasma Cells

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4
Q

What is the morphology of the blood in Multiple Myeloma?

A

Anemia

Rouleaux

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5
Q

What is Rouleaux?

A

Red cells stacking up on top of each other that look like coins due to disruption in the Zeta-potential

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6
Q

What is the morphology of the bone marrow in Multiple Myeloma?

A

Plasma Cells

Amyloid

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7
Q

What is a Russell Body?

A

Collection of immunoglobulin chains that were not secreted from the plasma cell sitting in the cytoplasm

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8
Q

What is a Dutcher Body?

A

Collection of immunoglobulin chains that were not secreted from the plasma cell sitting in the nucleus

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9
Q

What is a Mott Cell?

A

MULTIPLE collections of immunoglobulin chains that were not secreted from the plasma cell sitting in the nucleus

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10
Q

What does Amyloid stain with?

A

Congo Red (turns BRIGHT green)

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11
Q

What is Waldenstrom Macroglobulinemia?

A

Lymphoplasmacytoid Lymphoma that makes IgM

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12
Q

What is Monoclonal Gammopathy of Undetermined Significance (MGUS)?

A

Small M spike with no myeloma symptoms as people age

MAY transform into myeloma

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13
Q

Describe the normal maturation of plasma cells

A

Plasmablasts in the Lymph Nodes (IgM) –> Activated B-Cells in Bone Marrow (IgG, IgA) –> Differentiate into plasma cells

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14
Q

Describe the malignant maturation of plasma cells

A

Plasmablasts in Lymph Nodes –> Plasmablasts in Bone Marrow (IgG, IgA) –> Plasmablasts do not differentiate into plasma cells, proliferate and accumulate in bone marrow producing immunoglobulin that crowds out RBC precursors

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15
Q

What are the clinical symptoms of Multiple Myeloma?

A

Bone Pain - Low Back, Pelvis, Ribs associated with lytic bone lesions
Bruising/Bleeding due to decreased platelets
Infections due to decreased immunoglobulins

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16
Q

What is the classic triad of Multiple Myeloma?

A

Anemia
Bone Pain
Renal Failure

17
Q

What are the clinical signs of Multiple Myeloma?

A

Hypercalcemia from lytic bone lesions
Renal Failure
Hyperviscosity Syndrome

18
Q

What is Hyperviscosity Syndrome?

A

Caused by large amounts of circulating immunoglobulins causing purpura, confusion, decreased vision

19
Q

What are the criteria for diagnosis of Multiple Myeloma?

A

1) Bone Marrow with >20% plasma cells
OR
2) Plasmacytoma with one of the following:
Monoclonal Protein in serum > 3 g/dl
Monoclonal Protein in Urine
Lytic Lesions

20
Q

What is the treatment for Multiple Myeloma?

A

Symptomatic disease should be treated related to age and coexisting conditions with:

Dexamethasone (Steroid)
Melphalan (Alkylating Agent)
Cyclophosphamide (Alkylating Agent)

21
Q

What is an autologous peripheral blood stem cell transplant (PBSC)?

A

Hematopoietic stem cells from peripheral blood with growth factors given after transplantation
- Safe, but can have contamination of the autologous graft by myeloma cells

22
Q

What are some new treatments for Multiple Myeloma?

A

Thalidomide (Antiangiogenic Agent)
Lenalidomide (Antiantiogenic Agent)
Bortezomib (Proteasome Inhibitor)

23
Q

What are new supportive therapies for Multiple Myeloma?

A

Biphosphonates (inhibits bone resorption)

Erythropoietin (increases RBC)

24
Q

What is the prognosis for Multiple Myeloma?

A

Conventional Chemotherapy: 3-4 years

Intensive Therapy: under age 45, 50% with 10 year survival

25
Q

What causes death in patients with Multiple Myeloma?

A 
Marrow replaced with pancytopenia
Renal Failure
Sepsis
Acute Leukemia
Other Chronic Illnesses

IHO Week 4 (15 decks)

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