Waldenstrom's and Multiple Myeloma

Question 1

Multiple Myeloma

Answer 1

B cell neoplasm of older people (70 yo is median age.

Manifests with osteolytic bone lesions

Commonly there is a serum monoclonal protein along with monoclonal light chains in the urine (Bence Jones protein)

Question 2

Multiple Myeloma bone marrow biopsy will show…

Answer 2

sheets of plasma cells

Question 3

what two cytokines do myeloma cells release that cause bone lysis

Answer 3

Receptor Activator of Nuclear Factor-KB Lingand (RANKL): stimulates osteoclast formation and activity

Dickkopf1 (DKK1): inhibits osteoblasts

Question 4

Receptor Activator of Nuclear Factor-KB Lingand (RANKL)

Answer 4

cytokine from myeloma cell, stimulates osteoclast formation and activity, leading to bone erosion

Question 5

Dickkopf1 (DKK1)

Answer 5

inhibits osteoblasts, which prevents repair of lesions

Question 6

Why do some Multiple myeloma patients have significant hypercalcemia

Answer 6

osteoclast activity with bone breakdown and calcium mobilization. osteolytic lesions breakdown calcium phosphate, leading to the hypercalcemia seen on chem panel.

Question 7

Why does monoclonal gammopathy result in an “M spike”

Answer 7

homogeneity of immunoglobulin molecules secreted by a single clone of aberrant plasma cells

Question 8

Monoclonal gammopathy “M spikes” with multiple myeloma and Waldenstrom’s macroglobulinemia

Answer 8

Most myelomas are IgG and IgA, but can rarely have D, E and M

Waldenstroms is most commonly IgM

Question 9

What is a monoclonal protein

Answer 9

Heavy chain (Ig) either A, D, G, E, M
Light chain either lambda or kappa

example is IgA Kappa

Question 10

Underlying immune abnormality in MM and infections associated with MM

Answer 10

hypogammaglobulinemia

S. pneumo, H. influenza, N. meningitidis

Question 11

Bence-Jones Protein

Answer 11

think kidneys and MM. this is why you can get prominent kidney tubule damage with MM (light chain cast nephropathy). Bence-Jones proteins can also be seen with Waldenstrom’s

Question 12

renal problems in multiple myeloma

Answer 12

1- Renal Failure occurs in 25%
2- Renal disease occurs in over 50%
3- Myeloma kidney
4- Hypercalcemia. Early affects tubular lining cells. Later can get calcium stones

Question 13

What is commonly seen in peripheral blood smear in MM

Answer 13

Rouleux- coin stack appearance of RBCs

normochromatic, normocytic anemia

Question 14

Cryoglobulin

Answer 14

assocaited with MM. clusters at cold temperatures, which can lead to ischemic necrosis with MM

Question 15

Clinical features of Multiple Myeloma

Answer 15

1. osteoporosis, Hypercalcemia, pathologic fractures, lytic bone lesions, bone pain
2. renal failure
3. easy fatigue/ anemia
4. recurrent infections
5. neurologic symptoms
6. nausea and vomiting
7. bleeding/ clotting disorders