myeloma Flashcards
Causes of renal disease in myeloma
myeloma kidney/cast nephropathy (damage to tubule)
Monoclonal immunoglobulin deposition disease - usually light chain)- glomerular process
Amyloid
Hypercalcaemia
Cryoglobulins
Contrast media
Fanconi’s syndrome
Which gene is always degraded in myeloma?
MMSET
What is needed for diagnosis!
10% clonal BM plasma cells
And
Monoclonal protein in serum or urine
Or if non secretory need 30 percent plasma cells or biopsy proven plasmacytoma
Most common PC
Bone pain
Hyperviscosity syndrome sx
Ccf Ataxia Parasthesias Blurred vision Hearing loss Headache ataxia
Most common type para protein?
IgG
Then IgA
Then Light chain only (no para protein but bench jones and serum free light chains)
Then IgM
Do you get bence jones on dipstick?
No
What’s does beta 2microglobulin relate to?
Median survival 12 months if up
Poor prognosis factors?
Any kary abnormality But especially -hypodiploify -t 14;4 -del 17p13 -high beta 2 micro and LDH -ISS 3
Good if t 11;14, Normal beta 2 micro, normal LDH
Treatment myeloma
If no symptoms no benefit early treatment
If under 65 and no massive organ dysfunctioninductionwith thal or lenalidomide or bortezomib and then auto
If over 65 thal or bortezomib/melphalan /pre
And lenalidomide consolidation
High dose Dex if sc compression, incipient renal failure, extensive pain
Treatment at relapse?
If over 2 years same again
If under two years change Tx
Bisphosphonates?
Good
May improve prognosis
What’s the problem with thalid and lenalidomide?
Venous and arterial thrombosis
What do you do with bortez peripheral neuropathy
Kid mild reduce dose
If bad then stop and introduce lower dose once better
What bad things can MGUS become?
Myeloma Amyloid Plasmacytoma CLL Waldenstroms macro
