Myeloma Flashcards

1
Q

Pathophysiology

A
  1. Clonal expansion of abnormal, proliferating plasma cells producing a monoclonal paraprotein (IgG or IgA)
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2
Q

What would be seen in the urine in people with Myeloma

A

Excretion of light chains in the urine due to paraproteinaemia

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3
Q

What age group does Myeloma tend to effect

A

Elderly

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4
Q

Three clinical features of a myeloma

A
  1. Bone destruction
  2. Bone marrow infiltration with plasma cells
  3. Kidney Injury
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5
Q

Consequence of bone destruction

A

Fractures of long bones or vertebral collapse

Hypercalcaemia

Plasmacytosis

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6
Q

Consequence of Bone marrow infiltration with plasma cells

A

Anaemia

Thrombocytopenia

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7
Q

How does kidney injury occur

A

Position of light chains in renal tubules

Hypercalcaemia

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8
Q

Cytogenetic analysis should show what in patients with myeloma

A

FISH should show abnormal chromosome 13 and hypodiploidy

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9
Q

How else does myeloma effect the bone

A
  1. Dysfunction of bone remodelling
  2. Leads to lesions in spine, skull + long bones

Increased osteoclastic activity with no increased osteoblast formation of bone

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10
Q

Symptoms of Myeloma

A
  1. Bone pain (backache)
  2. Anaemia
  3. Recurrent infections
  4. Renal failure
  5. Hypercalcaemia
  6. Thrombocytopenia
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11
Q

What should we see in blood tests in people with myeloma

A

NORMAL BLOOD COUNT

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12
Q

What is the erythrocyte sedimentation rate in myeloma

A

High

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13
Q

What should we see on a blood film

A

Rouleaux formation as a consequence of paraprotein formation and plasma cells

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14
Q

Serum calcium levels in myeloma

A

Raised

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15
Q

Total protein count in myelomas

A

Raised

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16
Q

What would radiological signs of myeloma be

A
  1. Skeletal survey - Show characteristics of lytic lesions, most easily seen in the skull
  2. MRI spine is useful is there is back pain (shows collapse)
17
Q

How is Symptomatic Myeloma diagnosed

A

If either the following is present:

  1. Significant Paraproteinaemia
  2. Increased bone marrow plasma cells
18
Q

How is asymptomatic myeloma diagnosed

A
  1. Significant paraproteinaemia + marrow plasmocytosis
19
Q

What is considered significant paraproteinaemia

A

IgG>30g/dL

20
Q

What is a plasmacytoma

A
  1. Isolated tumour of neoplastic plasma cells
21
Q

What indicates a poor prognosis of myeloma

A
  1. Reduced serum albumin
  2. Increased serum betamicorglobulin
  3. Increased LDH
22
Q

Is Myeloma curable

23
Q

What ethnicity does Myeloma tend to effect

A

Afro-caribbeans

24
Q

How does Myeloma cause back pains

A

Activation of osteoclasts increase bone turnover and lytic lesions

Osteoblasts are inhibited reducing new bone formation

25
What two compounds activate osteoclasts
RANK ligans and IL-3
26
What molecules inhibit osteoblasts
HGF and Dkk-1
27
Why does myeloma result in recurrent bacterial infections
Neutropenia - causes high neutrophil count in healthy individuals
28
How is Myeloma treated
All patients given bisphosphonate
29
Name a bisphosphonate
Zolendronbte
30
Role of Bisphosphonate
Reduces bone pain and fracture rates
31
Why do we avoid NSAIDS
Risk of renal impairment
32
How is anaemia corrected
Transfusion of RBCs and erythropoietin
33
how to prevent renal damage
And rehydrate with 3L a day to prevent further renal damage
34
How is acute renal failure from myeloma treated
Renal dialysis
35
Describe the chemotherapy used for myeloma
1. CTD - Cyclophosphamide, Thalidomide, Dexamethasone | 2. VAD (Vincristine, Adriamycin, Dexamethasone)
36
How many cycles of CTD can you do
8
37
How many cycles of VAD can you do
6
38
When is CTD chosen as treatment
Less fit people
39
How do Bisphosphonates function
They inhibit osteoclasts so reduce bone resorption