Myeloma

Question 1

Definition

Answer 1

Plasma cell malignancy

Question 2

Myeloma is a major cause of panproteinaemia. True or false?

Answer 2

True

Question 3

Pathogenesis

Answer 3

Normal plasma cells -> genetic hit -> MGUS clones.

-> several more hits -> asymptomatic myeloma -> several more hits -> malignant myeloma

Question 4

What is asymptomatic myeloma

Answer 4

Malignancy is present but there is no organ damage

Question 5

Clonal plasma cells in myeloma affect the body in two ways:

Answer 5

Direct tumour cell effects

Paraprotein mediated effects

Question 6

How does myeloma affect the body - direct tumour cell effects

Answer 6

Bone lesions
Increased calcium
Bone pain
Replacement of normal bone marrow -> marrow failure

Question 7

How does myeloma affect the body - paraprotein mediated effects

Answer 7

Renal failure
Immune suppression
Hyperviscosity
Amyloid

Question 8

How is myeloma classified?

Answer 8

By the type of antibody produced

Question 9

What Ig is the most common form of myeloma?

Answer 9

IgG

Question 10

What Ig is the SECOND most common form of myeloma?

Answer 10

IgA

Question 11

Give example of a bone lesion seen in myeloma in the skull

Answer 11

Lytic bone lesion - multiple punched out lytic lesions in the skull

Question 12

Give an example of a bone lesion seen in myeloma in the vertebrae

Answer 12

Wedge compression fracture

Question 13

Pathogenesis - specific to bone disease

Answer 13

Myeloma interacts with bone marrow stream cells to produce cytokines which SUPRESS new bone production but STIMULATE OSTEOCLASTS (bone breakdown).

Question 14

There is a net gain/loss of bone in myeloma

Answer 14

Loss

Question 15

In myeloma there is INCREASED/DECREASED destruction of bone and INCREASED/DECREASED production of bone

Answer 15

Increased destruction

Decreased production

Question 16

Which medication can be used to interrupt this process that occurs in the bones?

Answer 16

Bisphosphonates

Question 17

Myeloma causes hypocalcaemia - true or false?

Answer 17

False

- myeloma causes hypercalcaemia

Question 18

Hypercalcaemia - features

Answer 18

Stones 
Bones 
Abdominal groans 
Psychiatric moans 
Thirst 
Dehydration
Renal impairment

Question 19

Renal impairment and myeloma

Answer 19

Light chain Ig deposition can clump together to form casts. This can cause blockages in the kidneys

Question 20

Cast nephropathy - management

Answer 20

Hydration

Switch off light chain production with steroids/chemo

Question 21

At what age group are people normally diagnosed with myeloma?

Answer 21

65

Question 22

Myeloma - management - mainstay of treatment

Answer 22

Combination chemotherapy

Question 23

Myeloma - management

Answer 23

Combination chemo
Steroids
- dexamathesone or prednisolone
Alkylating agents

Question 24

Myeloma - management for fit patients

Answer 24

High dose chemo/autologous stem cell transplantation

Question 25

How do you measure level of response to treatment

Answer 25

Check paraprotein levels

Question 26

Myeloma - treatment can cure the disease. True or false?

Answer 26

False

- treatment is just to control the disease but relapse is inevitable

Question 27

Myeloma - symptomatic control

Answer 27

Opiate analgesia
Local rradiotherapy
Bisphosphonates

Question 28

Why are bisphosphinates used?

Answer 28

Corrects hypercalcaemia and bone pain.

Can try to switch off the accelerated bone destruction