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Haematology > Myeloma > Flashcards

Myeloma Flashcards

1
Q

What is myeloma?

A

• Myeloma is a type of cancer affecting the plasma cells in the bone marrow.

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2
Q

What does cancer of the plasma cells lead to production of?

A

specific paraprotein (or M protein), which is an abnormal antibody or part of an antibody.

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3
Q

What is multiple myeloma?

A

• Multiple myeloma is where the myeloma affects multiple bone marrow areas in the body.

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4
Q

What is monoclonal gammopathy of undetermined significance?

A

• Monoclonal gammopathy of undetermined significance (MGUS) involves the production of a specific paraprotein without other features of myeloma or cancer.

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5
Q

What is smouldering myeloma?

A

• Smouldering myeloma involves abnormal plasma cells and paraproteins but no organ damage or symptoms.

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6
Q

What proteins are found in urine in myeloma?

A

Bence Jones priteins

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7
Q

What are the 4 key features of myeloma?

A

Crab

C – Calcium (elevated)
R – Renal failure
A – Anaemia
B – Bone lesions and bone pain
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8
Q

What is the most common complication of myeloma?

A

Anaemia

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9
Q

What type of anaemia is seen in myeloma?

A

Normocytic and normoblastic

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10
Q

What does myeloma bone disease result from?

A

increased osteoclast activity and suppressed osteoblast activity.

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11
Q

What are the most common sites of myeloma bone disease? (4)

A

○ The skull
○ Spine
○ Long bones
○ Ribs.

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12
Q

What do the bones look like in myeloma bone disease?

A

• The abnormal bone metabolism is patchy, meaning that the bone becomes very thin in some areas while others remain relatively normal.
These patches of thin bone are described as osteolytic lesions.

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13
Q

What can myeloma bone disease lead to?

A

Pathological fractures

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14
Q

What is the cause of hypercalcaemia in myeloma?

A

Increased osteoclast activity causing calcium reabsorption

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15
Q

What are plasmactyomas?

A

• Plasmacytomas are individual tumours formed by cancerous plasma cells.

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16
Q

What are some of the causes of renal disease in myeloma? (5)

A

• Paraproteins deposited in the kidneys
• Hypercalcaemia affecting kidney function
• Dehydration
• Glomerulonephritis (inflammation around the glomerulus and nephron)
• Medications used to treat the condition

17
Q

What happens to plasma viscosity in myeloma? Why?

A

• Plasma viscosity increases when more proteins are in the blood, such as the paraproteins found in myeloma.

18
Q

What can hyperviscosity syndrome cause? (4)

A

○ Bleeding (e.g., nosebleeds and bleeding gums)
○ Visual symptoms and eye changes (e.g., retinal haemorrhages)
○ Neurological complications (e.g., stroke)
○ Heart failure

19
Q

What are some risk factors of myeloma? (5)

A

Older age
Male
Black ethnic origin
Family history
Obesity

20
Q

What are some features or myeloma? (8)

A

• Persistent bone pain (e.g., spinal pain)
• Pathological fractures
• Unexplained fatigue
• Unexplained weight loss
• Fever of unknown origin
• Hypercalcaemia
• Anaemia
• Renal impairment

21
Q

What is used as a diagnostic investigation for myeloma?

A

Bone marrow biopsy

22
Q

What is the order of preference of imaging for bone lesions in myeloma? (3)

A

• Whole-body MRI
• Whole-body low-dose CT
• Skeletal survey (x-ray images of the entire skeleton)

23
Q

What X-ray findings are seen in myeloma? (4)

A

• Well-defined lytic lesions (described as looking “punched-out”)
• Diffuse osteopenia
• Abnormal fractures
• Raindrop skull (sometimes called pepper pot skull) refers to multiple lytic lesions seen in the skull on an x-ray.

24
Q

What is the management course of myeloma?

A

• It takes a relapsing-remitting course and is never fully cured.

25
Q

What is the treatment of myeloma? Give examples (3)

A

Combination of chemo

• Bortezomib (a proteasome inhibitor)
• Thalidomide
• Dexamethasone
26
Q

What are 2 types of stem cell transplant?

A

• Autologous (using the person’s own stem cells)
Allogeneic (using stem cells from a healthy donor)

27
Q

What further treatment can be done in fit patients with myeloma after chemo?

A

Stem cell transplant

28
Q

What is used to manage myeloma bone disease? (4)

A

• Bisphosphonates to suppress osteoclast activity
• Radiotherapy for bone lesions can improve bone pain
• Orthopaedic surgery to stabilise bones (e.g., by inserting a prophylactic intramedullary rod) or treat fractures
• Cement augmentation (injecting cement into vertebral fractures or lesions) to improve spine stability and pain

29
Q

What are some complications of myeloma? (10)

A

• Infection
• Bone pain
• Fractures
• Renal failure
• Anaemia
• Hypercalcaemia
• Peripheral neuropathy
• Spinal cord compression
• Hyperviscosity syndrome
• Venous thromboembolism

Haematology (18 decks)

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