Plasma Cell Neoplasms

Question 1

What happens in multiple myeloma?

Answer 1

Expansion of plasma cells in try bone marrow

Question 2

What can be seen in the peripheral blood on MM patients?

Answer 2

Realuex- stacking of red cells due to bridging of abnormal proteins

Question 3

What is an M spike?

Answer 3

in a plasma cell neoplasm you will have a monoclonal proliferation of a single type of immunoglobulin in serum electrophoresis analysis

Question 4

What are some things that need to be evaluated in a patient with newly diagnosed MM?

Answer 4

• CBC with differential
• Chemistry profile
• Calcium levels
• B2-microglobulin
• SPEP, IFX, and quantitative immunoglobulins

Question 5

What is the purpose of a CBC with differential in newly diagnosed MM patients?

Answer 5

determines degree of cytopenias (anemic)

Question 6

What is the purpose of a chemistry profile in newly diagnosed MM patients?

Answer 6

assess renal function

Question 7

What is the purpose of checking calcium levels in newly diagnosed MM patients?

Answer 7

hypercalcemia can occur leading to osteoclastic activity

Question 8

What is the purpose of checking B2-microglobulin in newly diagnosed MM patients?

Answer 8

prognostic factor

Question 9

What is the purpose of checking SPEP, IFX, and quantitative immunoglobulins in newly diagnosed MM patients?

Answer 9

includes serum albumin; IFX is essential to id cases with no M spike

quantitative immunoglobulines can quantitate amount of IgG, igM, IgA, IgD separate from SPEP

Question 10

What is the purpose of checking 24-hr UPEP and IFX in newly diagnosed MM patients?

Answer 10

Bence Jones proteins in urine can damage kidneys

Question 11

How is MM diagnosed

Answer 11

• M protein in serum or urine
• Marrow clonal plasma cells or plasmacytoma
• related organ or tissue impairment

Question 12

What does MM relate in physically?

Answer 12

Calcium-hypercalcemia
Renal insufficiency
Anemia
Bone destruction

Question 13

What does Bone destruction lead to?

Answer 13

• pain
• fractures
• spinal cord compression

Question 14

What does hypercalcemia lead to?

Answer 14

• altered mental status

- renal insufficiency

Question 15

How do MM patients present?

Answer 15

• bone pain
• fatigue
• anemia
• renal insufficiency
• hypercalcemia

Question 16

M-protein on SPE can be seen in what percentage of MM patients?

Answer 16

80%

Question 17

M-peak on IF of serum or urine can be seen in what percentage of MM patients?

Answer 17

97%

Question 18

Most MM is of what immunoglobulin type?

Answer 18

G-50%
A-20%
M-20%
light chain only-15%

Question 19

T or F. Clonal proliferation of plasma cells is a continuum from fairly benign to severe disease

Answer 19

T.

Question 20

What is the first step in the clonal progression?

Answer 20

MGUS- an abnormal clone of plasma cells producing an abnormal immunoprotein but not causing any damage and M protein is pretty small

about 5% over 80 yo have it

Question 21

What is the rate of progression of MGUS to monoclonal B cell malignancy?

Answer 21

1%/yr

Question 22

One step up from MGUS is what?

Answer 22

Smoldering myeloma

Question 23

How is Smoldering myeloma defined?

Answer 23

M-protein in serum greater than 30g/L (3mg/dl) and/or BM clonal plasma cells over 10%

No related organ or tissue impairment or symptoms (No CRAB)

Question 24

One step up from smoldering myeloma is what?

Answer 24

symptomatic MM

Question 25

How is symptomatic MM defined?

Answer 25

• presence of M-protein in serum and/or urine

related organ or tissue impairment

Question 26

How does MM cause bone disease?

Answer 26

-myeloma cells produce DKK1, leading to increase in RAKL and iL6 by osteoblast progenitor cells

Question 27

Increased in RANKL and IL6 causes what?

Answer 27

-osteoblast differentiation is blocked and osteoclast maturation is stimulated