Muyltiple Myeloma 3/23/13

Question 1

What is an M spike?

Answer 1

When doing gell electrophoresis on the serum of a MM patient, you will get an M spike because of the over production of monoclonal antibodies.

Question 2

What is multiple myeloma?

Answer 2

A malignancy of late B cells that mature principally into neoplastic plasma cells that generally produce a complete and or partial light chain immunoglobulin antibody

Question 3

What is an IFE?

Answer 3

Immunofixation test

Question 4

What does the immunofixation test tell you?

Answer 4

It will tell you what type of monoclonal antibody it is is. (IgE kappa. IgG lambda etc…

Question 5

Name the four components of CRAB

Answer 5

hyperCalcemia (leads to renal problems and mental impairment), Renal failure/insufficiency, Anemia, Bone destruction…..also can develop hypogammaglobulinemia which leads you susceptible to infection, amyloidosis, visouc blood.

Question 6

What is MGUS?

Answer 6

Monoclonal gammopathy of uncertain significance. Not multiple Myeloma but it is a precursor. You have M protein in the serum and some bone marrow clonal plasma cells but no organ or tissue impairment.

Question 7

What signals a transition from MGUS to myeloma?

Answer 7

Increased protein

Question 8

What is SMoldering Myeloma?

Answer 8

Basically in between MGUS and Multiple Myeloma

Question 9

Mechanism of bone destruction in MM

Answer 9

osteoblast differentiation is blocked by RANKL which stimulates osteoclast production. The DKK1 produced by myeloma cells is what stimulates RANKL production.

Question 10

What are the two staging systems for MM?

Answer 10

Durie Salmon and ISS

Question 11

Describe ISS staging

Answer 11

Only looks at Beta 2 Microglobulin and Albumin.
Stage 1- Normal B2M and normal Alb
Stage 2- in between
Stage 3- B2M over 5.5

Question 12

Describe Durie Salmon staging

Answer 12

Stage 1- Hb above 10, Ca below 12, M protein below 5, Bence Jones below 4
Stage 2- in between
Stage 3- Hb below 8.5, Ca above 12, M pro above 7
Most everyone that presesnts is stage 3

Question 13

Whats the worst prognostic indicator in MM

Answer 13

del 17p

Question 14

What two classifications of new drugs have changed the way MM is treated?

Answer 14

IMiDs and Proteasome inhibitors

Question 15

What the hell is an IMiD

Answer 15

An immune modulator (hence the IM) that works by activating NK cells to destroy tumor cells. Also alter the stromal structure that may stimulate myeloma cells.

Question 16

What is the major proteasome inhibitor used against MM?

Answer 16

Bortezomib

Question 17

How does Bortezomib work>

Answer 17

Proteasomes degrade proteins. In some way, inhibiting this destroys the Myeloma cell. I have no idea….

Question 18

Why do you use an autologous transplant?

Answer 18

Its a way of giving high does chemo to the bone marrow alone. You take the marrow out, blast it, put it back in.

Question 19

When is autologous transplant used?

Answer 19

If you are under 70 and in decent health

Question 20

What is Waldenstrom’s macroglobulinemai

Answer 20

Excess IgM. Low grade lymphoma.

Most who present are over 40, fatigue wt. loss, abnormal bleeding Hyperviscosity syndrome

Question 21

WHy do they present with Hyperviscosiity syndrome more often than MM pts?

Answer 21

B/c IgM is a big ass molecule.

Question 22

What do you treat Waldenstrom’s macroglubulinemia with?

Answer 22

Rituximab- maybe, botezomib- maybe….mixing lymphoma and myeloma drugs

Question 23

Causes of Amyloidosis

Answer 23

Monoclona serum antibodies, transthyretin, Chronic osteomyelitis

Question 24

Who gets MM?

Answer 24

Old African Americans

Question 25

Morphology

Answer 25

Look for rouleax cells in blood.