Myeloma

Question 1

What are antibodies made up of?

Answer 1

2 heavy and 2 light chains

Question 2

Which antibody usually exists as a pentamer?

Answer 2

IgM

Question 3

Which antibody exists as a dimer?

Answer 3

IgA

Question 4

Which antibodies exist as a monomer?

Answer 4

IgD, IgE, IgG

Question 5

Which is the most common antibody in the blood?

Answer 5

IgG

Question 6

Which antibody is passed on in breast milk?

Answer 6

IgA

Question 7

What are plasma cells?

Answer 7

Cells that produce lots of antibodies and secrete them into your bloodstream

Question 8

Which cells exhibit an eccentric clock faced nucleus (nucleus over to one side) on staining?

Answer 8

Plasma cell

Question 9

What does it mean if the patient has a paraproetin?

Answer 9

That they have an underlying clonal B cell disorder

Question 10

What test do you do to look for paraprotein?

Answer 10

Serum electrophoresis

Question 11

In what region of the electrophoresis do you look for monocolonal antibodies?

Answer 11

Gamma

Question 12

After electorphoresis what test do you do to classify the specific antibody that has become multiclonal?

Answer 12

Serum immunofixation

Question 13

What is normal daily free light chain production?

Answer 13

0.5g per day

Question 14

If you are producing too many antibody light chains where does the excess go?

Answer 14

Excreted in urine

Question 15

What is myeloma a cancer of?

Answer 15

Plasma cells

Question 16

What are the two reasons why m=patients with multiple myeloma get ill?

Answer 16

1. Direct tumour cell effects
   - Bone lesions
   - Increased calcium
   - Bone pain
   - 2. Paraprotein mediated effects
   - Renal failure
   Immune suppression
   Hyperviscosity
   Amyloid

Question 17

What is the most common type of myeloma?

Answer 17

IgG

Question 18

What kind of bone lesions do you see in myeloma?

Answer 18

Lytic “punched out” lesions

Question 19

What cell break down old bone?

Answer 19

Osteoclasts

Question 20

What cells build bone?

Answer 20

Osteoblasts

Question 21

What type of bone cells are activated in myeloma?

Answer 21

Osteoclasts

Question 22

What types of cells are supressed in myeloma?

Answer 22

Osteoblasts

Question 23

What are the symptoms of hypercalcaemia?

Answer 23

Stones
Bones
Abdominal groans
Psychiatric ,moans

Thirst
Dehydration
Renal impairement

Question 24

Why do patients with myeloma get kidney damage?

Answer 24

1. Tubular cell damage by light chains (more light chains = worse kidney damage)
2. Light chain deposition resulting in cast nephropathy.
3. Sepsis
4. Hypercalcemia and dehydration
5. Drugs (NSAIDs) taken for pain
6. Amyloid

Question 25

How do you treat cast nephropathy?

Answer 25

Switch of light chain production with steroids/ chemo

Question 26

What is the treatment for myeloma?

Answer 26

1. Steroids 2. Alykylating agents (cyclophosphamide, melphalan) 3. Novel agents such as thalidomide 4. Monoclonal antibodies 5. Stem cell transplants

Question 27

How do you monitor the response to treatment in myeloma?

Answer 27

Electrophoresis to look at paraprotein level

Question 28

What drugs would you give in myeloma to correct hypercalcaemia and bone pain?

Answer 28

Bisphosphonates

Question 29

What is the most common cause of paraproteins?

Answer 29

Monoclonal Gammopathy of Uncertain Significance

Question 30

What does the paraprotein level have to be to be MGUS?

Answer 30

Less than 30g/l

Question 31

What is the risk of MGIS turning into myeloma?

Answer 31

Around 1%

Question 32

What is Amyloid Lightchain Amyloidosis?

Answer 32

Protein deposition is organs tissues. These then interfere with the organ function and cause damage.

Question 33

What is the structure of AL amyloid in tissue?

Answer 33

Insoluble beta pleated sheet

Question 34

How do you diagnose AL amyloid?

Answer 34

Biopsy of the affected area and analysis using congo red stain

Question 35

What is the stain for amyloid?

Answer 35

Congo red

Question 36

What is lymphoplasmacytoid neoplasm?

Answer 36

Clonal disorder of cells intermediate between a lymphocyte and a plasma cell

Question 37

What is the paraportein in lymphoplasmacytoid neoplas?

Answer 37

IgM

Question 38

What are the clinical features of Waldenstrom’s Macroglobulinaemia 
(IgM paraprotein)

Answer 38

``` Hyperviscosity syndrome - Fatigue - Bleeding - Confusion B cell symtpoms - Weight loss - Night sweats ```

Question 39

What is the treatment of Waldenstrom’s Macroglobulinaemia
(IgM paraprotein)

Answer 39

``` Chemotherapy Plasmapheresis (removed paraprotein from the circulation) ```

Question 40

What does plasmaphoresis do in Waldenstrom’s Macroglobulinaemia
(IgM paraprotein)?

Answer 40

Removes IgM paraprotein and replace with donor plasma