Plasma Cell Dyscrasias Flashcards
Abnormal clonal proliferation of immune globulin-secreting differentiated B lymphocytes
Plasma cell dyscrasias
3 Plasma Cell dyscrasias
Multiple myeloma
MGUS
Waldenstrom macroglobulinemia
Light-chain associated amyloidosis
Mnemonic for Multiple myeloma
C- hypercalcemia
R- Renal Failure
A- Anemia
B- Bone disease: lytic lesions, fractures or osteoporosis
Diagnostic Tests for MM
CBC, Chemistry, SPEP, UPEP, Serum and urine immunofixation, serum free light chain, serum IgG, IgA, IgM
Low anion gap
IgM Gammopathies are more likely associated with
B-cell lymphoma
Imaging to get with IgM gammopathy
CT CAP
Characterized by monoclonal protein
MGUS and MM
MGUS findings
Serum monoclonal protein <3g/dL
Bone marrow clonal plasma cells <10%
No end organ damage
Monoclonal gammopathy of renal significance
Fill in after reading renal section
Smoldering MM findings
Serum monoclonal protein >/= 3g/dL
Bone marrow clonal plasma cells >/= 10%
No end organ damage
Real MM requiring therapy findings
Serum monoclonal protein present
Bone marrow clonal plasma cells >10%
End-organ damage (CRAB)
Most smoldering MM patients progress to
MM requiring therapy or AL Amyloidosis
Back pain + MM
Get MRI to check for spinal cord impingement
___ should not be used with MM. ____ should be used to evaluate for bone lesions.
Bone scans; Skeletal survey
MM treatment
Induction chemotherapy
Some combo of:
1. Proteasome inhibitor (bortezomib)
2. Immunomodulator (thalidomide or lenolidomide)
3. Glucocorticoid (Pred or dex)
4. Alkylating agent (melphalan or cyclophosphamide) for nontransplant patients
Treatment for MGUS
None
Bortezomib and thalidomide are associated with high risk of
peripheral neuropathy
Patients taking Thalidomide, lenalidomide or pomalidomide are at increased risk of
VTE
Findings in AL amyloidosis
Nephrotic syndrome- enlarged kidneys
Delayed gastric emptying
Hepatomegaly
polyneuropathy
restrictive cardiomyopathy, low voltage ECG
Bleeding, periorbital purpura, factor X deficiency
macroglossia
Diagnose AL amyloidosis with
Birefringence under polarized light with congo red stain on:
abdominal fat pad biopsy
bone marrow biopsy
K/gamma light chain detection
M protein on SPEP or UPEP
Treatment for AL amyloidosis
similar to MM
Diagnose Waldenstrom Macroglobulinemia
Clonal lymphocytes, plasmacytoid lymphocytes, plasma cells, and immunoblasts >10% of bone marrow cellularity
or
M protein > 3g/dL
Presence of disease-related signs, symptoms or organ dysfunction
WM findings
LAD, hepatomegaly, splenomegaly, hyperviscosity
Treatment for WM
Medical emergency- Plasmapheresis
