Myeloma Flashcards
What is myeloma?
Cancer of plasma cells
What are the 2 types of myeloma?
Paraprotein myeloma
Light chain myeloma
What are the 2 most common paraproteins that occur in myeloma?
IgG
IgA
(All we hear is radio GA GA)
What type of immunoglobulin paraprotein is rare but associated with severe myeloma?
IgD
What is a paraprotein?
Monoclonal immunoglobulins
What are the 4 main features of myeloma?
CRAB
HyperCalcemia
Renal failure
Anaemia
Bone disease
What are some of the morphological features of myeloma?
Off-centred nuclei
Many active plasma cells
What is the most common presentation of myeloma?
Worsening back pain that doesn’t respond to treatment and tiredness
For any patient that presents with back pain, what exam should you do and why?
Neuro exam
Need to exclude any serious spinal disease like CES
When looking at protein and albumin levels, what would be diagnostic of myeloma and why?
High total protein levels but low albumin
The high protein level is due to an influx of paraproteins
Why are patients with myeloma at an increased risk of infection?
As they also have bone marrow failure, so they have neutropenia and can’t fight infections
As patients with myeloma are at an increased risk of infection, what antibiotic would you give as prophylaxis for PJP?
Co-trimoxazole
Why does hyperviscosity occur in myeloma?
As the increased number of immunoglobulins can clog up blood lol
How may hyperviscosity present?
Retinal haemorrhages
Headaches
Can you give myeloma patients a blood transfusion?
No, as the increased number of immunoglobulins results in hyperviscosity
What are the 2 types of light chain myeloma?
Kapa
Lambda
To determine the type of light chain myeloma, what do you look for?
Kappa:Lambda ratio
What is the most common type of light chain myeloma?
Kappa
Can paraproteins and light chains both occur at the same time in myeloma?
Of course
Chemotherapy is one of the treatments for myeloma, what is a potential complication and levels of what are greatly increased?
Tumour lysis syndrome
Increased levels of:
Urate
Phosphate
Potassium
For a blood test in myeloma, what would happen to the following:
A. Hb B. Total protein levels C. Albumin D. Creatinine E. Calcium F. Urea
A. Decreased B. Increased C. Decreased D. Increased E. Increased F. Increased
What are the main investigations to do for myeloma?
Serum electrophoresis Immunofixation Serum light chain levels Urine tests Bloods X-ray Bone marrow aspirate
On looking at an X-ray for a myeloma patient, what is a typical sign?
Pepper pot skull
Why do you do a urine test for myeloma?
As renal failure occurs
What urinary protein so you check for in myeloma?
Bence-Jones protein
What are the treatments for myeloma?
Chemotherapy and radiotherapy Targeted molecular therapy Biophosphonates Steroids Autologous stem cell transplant Surgical decompression Surgical pinning of long bones
How can you treat bone disease that occurs in myeloma?
Biophosphates
Surgical decompression
Surgical pinning of long bones
What type of biophosphonate is commonly used when treating bone disease in myeloma?
Zaledronic acid
What type of stem cell transplantation is used for myeloma and where do the stem cells comes from?
Autologous stem cell transplantation
Stem cells come from the patient
(Opposite of allogenic)
What type of bone lesions occur in myeloma?
Lytic bone lesions
What can you see on a blood film for myeloma?
Rouleaux formation
Circulating plasma cells
On a bone marrow aspirate for myeloma, what % of clinical plasma cells need to be present in bone marrow?
> 10
Greater than 10 percent
What bone diseases occur in myeloma?
Lyric lesions
Cord compression
Compound fractures
Apart from hyperviscosity, what else does an increase in immunoglobulins result in?
Amyloidosis
Hypogammaglobinemia
What investigation determines the type of immunoglobulin present in myeloma?
Serum electrophoresis
What are some of the risk factors for myeloma?
The elderly
What is myeloma associated with?
MGUS
Osteoporosis
Amyloidosis
What does MGUS stand for?
Monoclonal Gammopathy of Uncertain Significance
If you have an increased number of paraproteins, but have no symptoms and are clinically sound, what is the most likely diagnosis?
MGUS
Immunoglobulins are usually diverse and are sporadic in their arrangement. What do you call a colony of one type of immunoglobulin?
Paraproteins
Why does fatigue occur in myeloma?
As there is an increase in calcium levels, which results in decreased membrane excitability
What are the differentials for myeloma?
MGUS
Non-Hodgkins lymphoma
Amyloidosis
Leukaemia
Cigarettes increase the risk of getting pretty inch every cancer, what is an early sign of cancer in relation to cigarettes?
Gradual loss of liking the taste
How can MGUS develop into myeloma?
As the paraprotein count increases by 1% each year, so will gradually increase you risk of developing myeloma
What type of fractures occur in myeloma?
Pathological fracture
How does myeloma cause spinal cord compression?
Vertebral collapse (due to fractures) Plasma-cytoma
How is spinal cord compression treated?
High-dose steroids (to reduce swelling) Radiotherapy (if soft tissue mass) Surgical decompression (if non-soft tissue mass)
Before an autologous stem cell transplant, what is given to patients waiting to get one and why?
G-CSF
To stimulate stem cell production
Mucositis is a complication of chemotherapy, what symptoms can it cause?
Mouth pain
GI upset
Diarrhoea
If a patient has mucositis, can they receive a stem cell transplant?
No
It’s a contraindication
What syndrome, that is related to myeloma due to it also involving increased paraproteins, is characterised by: Polyneuropathy Organmegaly Endocrinopathy Monoclonal antibodies (paraproteins) Skin changes
POEMS syndrome
What is the closest treatment of being curative for myeloma?
Autologous stem cell transplant
Is myeloma curable?
Nah mate
How long can stem cells from an autologous stem cell transplant be frozen?
10 years
When you give high-dose steroids, what type of medication do you ALWAYS have to give to prevent GI upset?
PPI
What are urinary Bence-Jones proteins?
Light chains in urine
What is a good investigation to look at lytic bone lesions in myeloma?
CT skeletal survey
Why can a CT skeletal survey be used in myeloma?
As contrast is not involved, so it can be used in cases of renal failure (like in myeloma)
For PJP prophylaxis, when will Pentamidine be used ahead of cotrimoxazole and why?
In situations of BM failure (e.g. post chemo or SCT)
Because cotrimoxazole can cause agranulocytosis
What are the morphological signs of myeloma on a BM?
> 10% clonal plasma cells
Immature plasma cells
“Clock-face” nuclei
Eccentric nuclei
What are the morphological signs of myeloma on a blood film?
Rouleaux formation
Circulating plasma cells
Give 3 examples of chromosome mutations that can cause myeloma?
t(11,14)
11q deletion
13q14 deletion
What is the main stay management of myeloma?
Batter them with chemo, then give an autologous stem cell transplant
What is the triad of clinical features for myeloma?
> 10% clonal plasma cells
Lytic bone lesions
Free light chains in urine
What injections are given to myeloma patients who have BM failure and are in need of more RBCs?
EPO injections
What Ig tends to be decreased in hypogammaglobinemia?
IgG
