Multiple myeloma - need to redo

Question 1

What cells are affected in multiple myeloma?

Answer 1

Plasma cells (differentiated B-cells)

Question 2

What percentage of haematological cancers are MM?

Answer 2

About 10% (second to non-Hodgkins lymphoma)

Question 3

What two things happens to the affected plasma cell in MM?

Answer 3

They accumulate in bone marrow

Make too much of whichever immunoglobulin they make (+ paraproteins + factors that stimulate osteoclasts)

Question 4

Give three things the affected plasma cell will produce.

Answer 4

Immunoglobulin
Paraproteins
Factors which stimulate osteoclasts

Question 5

Why is the release of paraproteins by the plasma cells a bad thing?

Answer 5

They form protein casts in the renal tubules, leads to renal dysfunction.

Question 6

What are paraproteins?

Answer 6

Abnormal immunoglobulin light chains

Question 7

Myelomas can be classified by which type of immunoglobulin is produced. What are the main types and what ratios do they present in?

Answer 7

IgG - 2/3
IgA - 1/3
IgD and IgM - rare

Question 8

What’s the most common symptom for MM?

Answer 8

Bone pain - experienced by roughly 70%
(pain typically worsens with activity)

Question 9

What happens to calcium levels in MM?

Answer 9

you see hypercalcaemia due to resorption of bone

Question 10

Why can people with MM become immunocompromised?

Answer 10

Production of normal immunoglobulins is inhibited

Question 11

Give three things B-cells do

Answer 11

producer of antibodies
producer of cytokines
antigen presentation

Question 12

What triggers a B-cell to differentiate into a plasma cell?

Answer 12

Activation by an antigen

Question 13

What’s the mnemonic to remember the features of MM?

Answer 13

Question 14

What percentage of all cancers are myelomas?

Answer 14

about 1%

Question 15

What’s the difference between myeloma and multiple myeloma?

Answer 15

Myeloma = cancer of plasma cells
Multiple myeloma = affecting multiple parts of the body

Question 16

What three blood anaemias do you see in myeloma?

Answer 16

anaemia
neutropenia
thrombocytopenia

Question 17

Why do patients with MM have fragile bones?

Answer 17

Plasma cells accumulate in bone marrow and stimulate osteoclasts

Osteoclasts resorb bone, bone thins and weakens.

Question 18

people with MM can also develop plasmacytomas, what are these?

Answer 18

individual tumours made up of the cancerous plasma cell

Question 19

What happens to plasma viscosity in MM?

Answer 19

Increases due to increased levels of immunoglobulins in the blood

Question 20

What is normal levels of plasma viscosity compared to water?

Answer 20

1.3-1.7 x viscosity of water
(blood is 1.3-1.7 x thicker than water)

Question 21

What protein is found in the urine of someone with myeloma?

Answer 21

Bence-jones protein

Question 22

How would you test for bence-jones protein in the urine of someone with myeloma?

Answer 22

Urine electrophoresis

Question 23

What disease pattern does MM usually follow?

Answer 23

relapsing-remitting

Question 24

What’s the treatment for MM?

Answer 24

Anti-cancer drugs + a steroid
e.g thalidomide + dexamethasone