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HAEM (Haematology) > Myeloma > Flashcards

Myeloma Flashcards

1
Q

What is Myeloma?

A

A cancer of a specific plasma cell (B lymphocytes that produce antibodies) resulting in the production of large quantities of a single type of antibody.

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2
Q

What is Multiple Myeloma?

A

Myeloma that affects multiple areas of the body.

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3
Q

Risk Factors of Myeloma (5).

A
  1. Older Age (Median : 70).
  2. Male.
  3. Black African Ethnicity.
  4. Family History.
  5. Obesity.
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4
Q

What is Monoclonal Gammopathy of Undetermined Significance (MGUS)?

A

An excess of a single type of antibody or antibody components without other features of myeloma/cancer - an incidental finding with unclear significance (it may progress to myeloma so follow-up routinely).

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5
Q

What is Smouldering Myeloma?

A

A premalignant state where there is progression of MGUS with higher levels of antibodies/antibody components.

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6
Q

What is Waldenstrom’s Macroglobulinaemia?

A

A type of smouldering myeloma where there is excessive IgM specifically.

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7
Q

Pathophysiology of Myeloma.

A
  1. Significantly Abundant Production of a Specific Type of Immunoglobulin (50% of the time = IgG) = Monoclonal Paraprotein.
  2. Bone Marrow Infiltration = Anaemia, Neutropenia and Thrombocytopenia.
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8
Q

What are Bence Jones Proteins?

A

Subunits of the antibody - light chains found in the urine of myeloma patients.

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9
Q

Aetiology of Myeloma Bone Disease.

A

Increased Osteoclast (absorption) Activity and Suppressed Osteoblast (deposition) Activity – increased metabolism of bone due to cytokines released from plasma cells and stroll cells when in contact with plasma cells.

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10
Q

Common Sites of Myeloma Bone Disease (4).

A
  1. Skull.
  2. Spine.
  3. Long Bones.
  4. Ribs.
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11
Q

Clinical Consequence of Myeloma Bone Disease.

A
  1. Patches of thin bone - osteolytic lesions - pathological fractures.
  2. Hypercalcaemia (resorption of bone).
  3. Plasmacytomas (individual tumours made up of cancerous plasma cells occurring in bones, replacing normal bone tissue or outside bones in soft tissue of the body).
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12
Q

Aetiology of Myeloma Renal Disease (5).

A
  1. High Levels of Immunoglobulins block tubular flow.
  2. Hypercalcaemia.
  3. Dehydration.
  4. Medications e.g. Bisphosphonates.
  5. Amyloidosis, Nephrocalcinosis, Nephrolithiasis.
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13
Q

Aetiology of Hyperviscosity.

A

More proteins e.g. Immunoglobulins and Fibrinogen - blood is usually 1.3-1.7x more viscous than water but here it is more.

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14
Q

Clinical Consequences of Hyperviscosity (5).

A
  1. Easy Bruising.
  2. Easy Bleeding.
  3. Reduced/Loss of Sight (Vascular Disease in Eye).
  4. Purplish Palmar Erythema (Discolouration to Extremities).
  5. Heart Failure.
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15
Q

Clinical Features of Myeloma (4).

A

CRAB :

  1. C - Calcium (High).
  2. R - Renal Failure.
  3. A - Anaemia (Normocytic, Normochromic).
  4. B - Bone Lesions/Pain.
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16
Q

Clinical Features of Hypercalcaemia (4)

A
  1. Bones - Pain.
  2. Stones - Renal.
  3. Groans - Abdominal.
  4. Psychic Moans.
17
Q

Clinical Consequences of Hypercalcaemia in Myeloma (4).

A
  1. Constipation.
  2. Nausea.
  3. Anorexia.
  4. Confusion.
18
Q

Clinical Features of MGUS.

A

Asymptomatic usually but 10-30% have demyelinating neuropathy.

19
Q

Clinical Features of Waldenstrom’s Macroglobulinaemia.

A
  1. Monoclonal IgM Paraproteinaemia.
  2. Hyperviscosity Syndrome - Visual Disturbance (Pentameric Configuration increases Serum Viscosity).
  3. Hepatosplenomeglay and Lymphadenopathy.
  4. Cryoglobulinaemia - Raynaud’s.
20
Q

Initial Investigations of Myeloma (4).

A

BLIP :

  1. B - Bence-Jones Protein (Urine Electrophoresis).
  2. L - Serum Free Light Chain Assay.
  3. I - Serum Immunoglobulins.
  4. P - Serum Protein Electrophoresis.
21
Q

Blood Findings of Myeloma (4).

A

Raised :

  1. FBC.
  2. Calcium.
  3. ESR.
  4. Plasma Viscosity.
22
Q

Diagnostic Investigation of Myeloma.

A

Bone Marrow Biopsy.

23
Q

Imaging Investigations of Myeloma (3).

A
  1. Whole Body MRI.
  2. Whole Body CT.
  3. Skeletal Survey (X-Ray of Skeleton).
    * in order of preference
24
Q

X-Ray Findings of Myeloma (3).

A
  1. Punched Out Lesions.
  2. Lytic Lesions.
  3. Raindrop Skull - Punched Out Lesions through Skull.
25
Q

Peripheral Blood Film in Myeloma.

A

Rouleaux Formation.

26
Q

Diagnosis of Multiple Myeloma.

A

1 Major + 1 Minor or 3 Minor + Symptomatic.

27
Q

Major Criteria in Multiple Myeloma (3).

A
  1. Plasmacytoma (Biopsy Specimen).
  2. 30% Plasma Cells in Bone Marrow Sample.
  3. Elevated Levels of M Protein in Blood/Urine.
28
Q

Minor Criteria in Multiple Myeloma.

A
  1. 10-30% Plasma Cells in Bone Marrow Sample.
  2. Minor Elevations in M Protein Levels in Blood/Urine.
  3. Osteolytic Lesions (Imaging).
  4. Low Levels of Other Antibodies.
29
Q

Management of Myeloma.

A
  1. Aim : Control Disease - improve quality and quantity of life.
  2. MDT - Haematology & Oncology.
  3. 1st Line - Combination of Chemotherapy.
  4. Stem-Cell Transplantation (Clinical Trial).
  5. VTE Prophylaxis with Aspirin or LMWH when on Chemotherapy.
30
Q

Chemotherapy Agents in Myeloma (3).

A
  1. Bortezomid.
  2. Thalidomide.
  3. Dexamethasone.
31
Q

Induction Therapy in Multiple Myeloma (2).

A
  1. Suitable for Autologous Stem Cell Transplantation : Bortezomib + Dexamethasone.
  2. Not Suitable for Autologous Stem Cell Transplantation : Thalidomide, Alkylating Agent + Dexamethasone.
32
Q

Monitoring in Multiple Myeloma.

A

Every 3 months with Blood Tests and Electrophoresis.

33
Q

Management of Relapse.

A

Bortezomib Monotherapy.

34
Q

Management of Myeloma Bone Disease.

A
  1. Bisphosphonates - Suppress Osteoclast Activity.
  2. Radiotherapy to Bone Lesions - Improve Bone Pain.
  3. Orthopaedic Surgery - Stabilise Bones/Treat Fractures.
  4. Cement Augmentation - Improve Spine Stability and Pain.
35
Q

Complications of Myeloma (8).

A
  1. Infection.
  2. Pain.
  3. Hyperviscosity.
  4. Renal Failure.
  5. Anaemia.
  6. Hypercalcaemia.
  7. Peripheral Neuropathy.
  8. Spinal Cord Compression.

HAEM (Haematology) (35 decks)

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