FN: Multiple Myeloma Flashcards Preview

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Flashcards in FN: Multiple Myeloma Deck (21):
1

Epi

M=F
Black>White = 2:1
70yrs

2

Pathogenesis

1. clonal proliferation of plasma cells -- monoclonalraised Ig - usually IgG or IgA
2. Clones may also produce free light chain (kappa or lambda): 2/3
3. Clones produce IL-6 whcih inhibits osteoblasts (normal ALP) and activates oteoblasts

3

Free light chains excreted by and seen

Excreted by kidney - urinary BJP
Light chains only seen in plasma in renal failure

4

Symptoms

Osteolytic bone lesions
BM infiltration
Recurrent bacterial infections
Renal impairment

5

Osteolytic bone lesions

1. Backache and bone pain
2. PAthological fractures
3. Vertebral collapse

6

BM infiltration

anaemia
Neutropenia
Thrombocytopenia

7

Recurrent bacterial infections

Neutropenia
Immunoparesis (reduced Ig)
Chemotherapy

8

Renal Impairment

Light chains
Raised Calcium
AL-amyloid

9

complications

Hypercalcaemia
Neurlogical: raised Calcium, compression, amyloid
AKI
Hyperviscosity
AL-amyloid (15%)

10

Investigations

Bloods
Urine
BM biopsy
Xray

11

Bloods show

1. FBC: nromocytic normochromic anaemia
2. Film: rouleaux ± plasma cells ± cytopenias
3. Raised ESR/PV, raised U+Cr, raised Calcium, normal ALP
4. Se electrophoresis: BJP

12

Urine shows

Stix: raised specific gravity (BJP donesnt show)
Electrophoresis: BJP

13

X-ray Skeletal Pathoogy

Punched-out lytic lesions
Pepper-pot skull
Vertebral collapse
Fractures

14

Diagnosis

Clonal BM plasma cells >10%
Presence of se and/or urinary monoclonal protein
End-organ Damage: CRAB

15

CRAB

Calcium
Renal insufficiency
Anaemia (

16

Management

Supportive
Complications Rx
Specific

17

Supportive

Bone pain: Analgesia (avoid NSAIDS) + bisphosphonates
Anaemia: Transfusions and EPO
Renal impairement: ensure good hydration ! dialysis
Infections: broad spectrum Abx ± IVIg if recurrent

18

Complications

Raised Calcium: aggressive hydration, frusemide, bisphosphonates
Cord compression: MRI dexamethasone + local radio
Hyperviscosity: Plasmapheresis (remove light chains)
AKI: rehydration ± dialysis

19

Specific Rx for fit patients

Induction chemo: lenalidomide + low-dose dex
Them allogenic BMT

20

Specific RX for unfit pts.

Chemo only: melphalan + pred + lenalidomide
Bortezomib for relapse

21

Prognosis

Mean survival: 3-5 yrs
Poor prognostic indicators
1. Beta2 microglobulin
Reduced albumin

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