Plasma Cell Dyscrasias

Question 1

Abnormal clonal proliferation of immune globulin-secreting differentiated B lymphocytes

Answer 1

Plasma cell dyscrasias

Question 2

3 Plasma Cell dyscrasias

Answer 2

Multiple myeloma
MGUS
Waldenstrom macroglobulinemia
Light-chain associated amyloidosis

Question 3

Mnemonic for Multiple myeloma

Answer 3

C- hypercalcemia
R- Renal Failure
A- Anemia
B- Bone disease: lytic lesions, fractures or osteoporosis

Question 4

Diagnostic Tests for MM

Answer 4

CBC, Chemistry, SPEP, UPEP, Serum and urine immunofixation, serum free light chain, serum IgG, IgA, IgM

Low anion gap

Question 5

IgM Gammopathies are more likely associated with

Answer 5

B-cell lymphoma

Question 6

Imaging to get with IgM gammopathy

Answer 6

CT CAP

Question 7

Characterized by monoclonal protein

Answer 7

MGUS and MM

Question 8

MGUS findings

Answer 8

Serum monoclonal protein <3g/dL
Bone marrow clonal plasma cells <10%
No end organ damage

Question 9

Monoclonal gammopathy of renal significance

Answer 9

Fill in after reading renal section

Question 10

Smoldering MM findings

Answer 10

Serum monoclonal protein >/= 3g/dL
Bone marrow clonal plasma cells >/= 10%
No end organ damage

Question 11

Real MM requiring therapy findings

Answer 11

Serum monoclonal protein present
Bone marrow clonal plasma cells >10%
End-organ damage (CRAB)

Question 12

Most smoldering MM patients progress to

Answer 12

MM requiring therapy or AL Amyloidosis

Question 13

Back pain + MM

Answer 13

Get MRI to check for spinal cord impingement

Question 14

___ should not be used with MM. ____ should be used to evaluate for bone lesions.

Answer 14

Bone scans; Skeletal survey

Question 15

MM treatment

Answer 15

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

Question 16

Treatment for MGUS

Answer 16

None

Question 17

Bortezomib and thalidomide are associated with high risk of

Answer 17

peripheral neuropathy

Question 18

Patients taking Thalidomide, lenalidomide or pomalidomide are at increased risk of

Answer 18

VTE

Question 19

Findings in AL amyloidosis

Answer 19

Nephrotic syndrome- enlarged kidneys
Delayed gastric emptying
Hepatomegaly
polyneuropathy
restrictive cardiomyopathy, low voltage ECG
Bleeding, periorbital purpura, factor X deficiency
macroglossia

Question 20

Diagnose AL amyloidosis with

Answer 20

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

Question 21

Treatment for AL amyloidosis

Answer 21

similar to MM

Question 22

Diagnose Waldenstrom Macroglobulinemia

Answer 22

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

Question 23

WM findings

Answer 23

LAD, hepatomegaly, splenomegaly, hyperviscosity

Question 24

Treatment for WM

Answer 24

Medical emergency- Plasmapheresis