myeloma Flashcards
What is the condition that accounts for 99% of IgG spikes on SPEP?
MGUS
What is the only condition that gives >10% plasma cells on bone marrow biopsy?
Myeloma
what establishes the diagnosis of multiple myeloma?
monoclonal spike on SPEP + bony lytic lesions + >10% plasma cells on BM biopsy
initial orders for patient with “pathologic fracture”
Xray of the affected joint, spine xray, CBC, Chem 20, acetaminophen
why do you request for a spine xray in patients with pathologic fractures?
to look for compression fractures
treatment for bony lytic lesions
Bisphosphonates eg. alendronate or pamidronate
- inhibits osteoclasts
Results show: bony lytic lesions, compression fracture, high serum protein, high serum Ca++. what will you request next?
Start bisphosphonates. Request for SPEP, UA, uric acid, PBS. Oncology evaluation.
Results show: monoclonal IgG spike, PBS shows roleaux formation, NL uric acid and UA results. What will you request next?
Request for: Bone marrow biopsy. urine immunoelectrophoresis, beta-2 microglobulin. Repeat Calcium, uric acid and cbc.
Why do we request for beta 2 microglobulin in patients with myeloma?
it is elevated in myeloma and used as a marker of response to treatment
MOA of bortezomib
proteosome inhibitor
MOA of lenalidomide
TNF inhibitor
