Myeloma Flashcards
Definition
Plasma cell malignancy
Myeloma is a major cause of panproteinaemia. True or false?
True
Pathogenesis
Normal plasma cells -> genetic hit -> MGUS clones.
-> several more hits -> asymptomatic myeloma -> several more hits -> malignant myeloma
What is asymptomatic myeloma
Malignancy is present but there is no organ damage
Clonal plasma cells in myeloma affect the body in two ways:
Direct tumour cell effects
Paraprotein mediated effects
How does myeloma affect the body - direct tumour cell effects
Bone lesions
Increased calcium
Bone pain
Replacement of normal bone marrow -> marrow failure
How does myeloma affect the body - paraprotein mediated effects
Renal failure
Immune suppression
Hyperviscosity
Amyloid
How is myeloma classified?
By the type of antibody produced
What Ig is the most common form of myeloma?
IgG
What Ig is the SECOND most common form of myeloma?
IgA
Give example of a bone lesion seen in myeloma in the skull
Lytic bone lesion - multiple punched out lytic lesions in the skull
Give an example of a bone lesion seen in myeloma in the vertebrae
Wedge compression fracture
Pathogenesis - specific to bone disease
Myeloma interacts with bone marrow stream cells to produce cytokines which SUPRESS new bone production but STIMULATE OSTEOCLASTS (bone breakdown).
There is a net gain/loss of bone in myeloma
Loss
In myeloma there is INCREASED/DECREASED destruction of bone and INCREASED/DECREASED production of bone
Increased destruction
Decreased production
Which medication can be used to interrupt this process that occurs in the bones?
Bisphosphonates
Myeloma causes hypocalcaemia - true or false?
False
- myeloma causes hypercalcaemia
Hypercalcaemia - features
Stones Bones Abdominal groans Psychiatric moans Thirst Dehydration Renal impairment
Renal impairment and myeloma
Light chain Ig deposition can clump together to form casts. This can cause blockages in the kidneys
Cast nephropathy - management
Hydration
Switch off light chain production with steroids/chemo
At what age group are people normally diagnosed with myeloma?
65
Myeloma - management - mainstay of treatment
Combination chemotherapy
Myeloma - management
Combination chemo
Steroids
- dexamathesone or prednisolone
Alkylating agents
Myeloma - management for fit patients
High dose chemo/autologous stem cell transplantation
How do you measure level of response to treatment
Check paraprotein levels
Myeloma - treatment can cure the disease. True or false?
False
- treatment is just to control the disease but relapse is inevitable
Myeloma - symptomatic control
Opiate analgesia
Local rradiotherapy
Bisphosphonates
Why are bisphosphinates used?
Corrects hypercalcaemia and bone pain.
Can try to switch off the accelerated bone destruction
