Myeloma

Question 1

ISS Staging

Answer 1

Stage 1 - B2 micro globulin 3.5
Stage 2 - not stage I or III
Stage 3 - B2 micro globulin >5.5

Question 2

ISS prognosis

Answer 2

Stage 1 median 62 mo
Stage 2 median 44 mo
Stage 3 median 29 mo
Based on 2005 ISS

Question 3

Myeloma cytogentics - High Risk

Answer 3

FISH - t(14;16), t(14;20), del17p13 (10%) ,

Cytos - del 13 (conv cytos)

Question 4

Myeloma cytos - Intermediate risk

Answer 4

t(4;14) FISH or del13(FISH) - with velcade and auto can be turned into standard risk

del13q(FISH) is highly associated with 4;14 and may not be independent prognostic factor with FISH

Question 5

Myeloma cytos - standard risk

Answer 5

Trisomies (hyperdiploid)
t(11;14) (20%)
t(6;14)

50% of patient will have hyperdiploidy

Question 6

Myeloma - cytogenetics prognosis

Answer 6

Poor - median survival 25 month
Intermediate 42 mo median OS
Good - 50 mo median OS

Question 7

Myeloma IHC

Answer 7

● Kappa or lambda light chains (usually one markedly more than the other), CD38 (plasma cells), CD79a, CD138
● CD56 often positive on myeloma cells (67–79%) but negative in plasma cell leukemia as well as nl plasma cells
● Aberrant expression of CD117 > CD20 > CD52 > CD10; rarely expresses cyclin D1
● Negative CD19 (+ on nl plasma cells), CD20

Question 8

Myeloma - Pathology differential

Answer 8

●Lymphomas with extreme plasma cell differentiation - lymphoplasmacytic lymphoma, marginal zone, plasmblastic lymphoma, immunoblastic large cell lymphoma
● Typically these express CD19 and are negative for CD56

Question 9

Len/Dex

Answer 9

Len 25mg day d1-21
dex 40mg weekly
Superior to pulsed high dose Dex