Multiple myeloma - need to redo Flashcards
What cells are affected in multiple myeloma?
Plasma cells (differentiated B-cells)
What percentage of haematological cancers are MM?
About 10% (second to non-Hodgkins lymphoma)
What two things happens to the affected plasma cell in MM?
They accumulate in bone marrow
Make too much of whichever immunoglobulin they make (+ paraproteins + factors that stimulate osteoclasts)
Give three things the affected plasma cell will produce.
Immunoglobulin
Paraproteins
Factors which stimulate osteoclasts
Why is the release of paraproteins by the plasma cells a bad thing?
They form protein casts in the renal tubules, leads to renal dysfunction.
What are paraproteins?
Abnormal immunoglobulin light chains
Myelomas can be classified by which type of immunoglobulin is produced. What are the main types and what ratios do they present in?
IgG - 2/3
IgA - 1/3
IgD and IgM - rare
What’s the most common symptom for MM?
Bone pain - experienced by roughly 70%
(pain typically worsens with activity)
What happens to calcium levels in MM?
you see hypercalcaemia due to resorption of bone
Why can people with MM become immunocompromised?
Production of normal immunoglobulins is inhibited
Give three things B-cells do
producer of antibodies
producer of cytokines
antigen presentation
What triggers a B-cell to differentiate into a plasma cell?
Activation by an antigen
What’s the mnemonic to remember the features of MM?
What percentage of all cancers are myelomas?
about 1%
What’s the difference between myeloma and multiple myeloma?
Myeloma = cancer of plasma cells
Multiple myeloma = affecting multiple parts of the body
What three blood anaemias do you see in myeloma?
anaemia
neutropenia
thrombocytopenia
Why do patients with MM have fragile bones?
Plasma cells accumulate in bone marrow and stimulate osteoclasts
Osteoclasts resorb bone, bone thins and weakens.
people with MM can also develop plasmacytomas, what are these?
individual tumours made up of the cancerous plasma cell
What happens to plasma viscosity in MM?
Increases due to increased levels of immunoglobulins in the blood
What is normal levels of plasma viscosity compared to water?
1.3-1.7 x viscosity of water
(blood is 1.3-1.7 x thicker than water)
What protein is found in the urine of someone with myeloma?
Bence-jones protein
How would you test for bence-jones protein in the urine of someone with myeloma?
Urine electrophoresis
What disease pattern does MM usually follow?
relapsing-remitting
What’s the treatment for MM?
Anti-cancer drugs + a steroid
e.g thalidomide + dexamethasone
