Multiple Myeloma Flashcards Preview

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Flashcards in Multiple Myeloma Deck (17):
1

lymphoid stem cell development

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2

Lymphoid cells

T cells, B cells, plasma cells, NK cells

3

Monoclonal AB

MAde by 1 clone of plasma cells or lymphocytes

- consists of 1 class of heavy chain and 1 type of light chain (kappa or lambda)

4

Multiple myeloma

overview

proliferation of neoplastic plasma cells

cells are clinal and have monoclonal antibody production

high levels of this antibody found in blood and urine

5

Proliferation of plasma cells leads to:

1. crowding out of normal marrow cells

- pancytopenia, anemia, infections (mostly encapsulated bacteria), bleeding

2. bone lesions

- tumor growth + bone resorption

- Cells make IL-1 and other bone resortion factors

- "punched out" osteolytic lesions on xray

- bone pain, pathologic fractures

- hypercalcemia

3. increased cell turnover

- uric acid and calcium phosphate deposits

6

Criteria for MM dx

- monoclonal plasma cells in bone marrow

- monoclonal protein present in serum and/or urine 

- myeloma- related organ disfucntion

Calcium high in serum

Renal insufficiency

Anemia

Bone lesions or osteoporosis

7

Monoclonal AB production leads to:

1. elevated serum protein (hyperviscosity)

2. Hyperglobulinemia

- but effective hypoglobulinemia and increased infections

3. monoclonal spike on protein electrophoreisis

4. Rouleaux formation of RBcs on smear

- RBCs stick together

5. excess light chains

- in urine and serum

- renal failure and amyloidosis

6. ABs coat coag factors

- may see bleeding

8

Multiple myleoma types

IGG--- MOST COMMON, CLASSIC FINDINGS

IGM--- HYPERVISCOSITY, USUALLY WALDENSTROMS

IGA ---MAY HAVE “FLAME CELLS” (SECRETORY PART)

IGD--- RARE, MAY MISS ON IEP (NEED ANTI-D)

IGE--- RARE. MAY PRESENT WITH PC LEUKEMIA

LIGHT CHAIN ONLY--- (HYPOGLOBULINEMIA ON SPEP, +UPEP)

NULL---  (NO SECRETION OF AB BUT HAVE NEOPLASTIC PROLIF OF
                 PLASMA CELLS IN MARROW, USUALLY HYPOGLOBULINEMIC)

 

9

1. Plasmacytoma

2. plasma cell leukemia

 

1. isolated collection of plasma cells, plasma cell tumor

2. neoplastic plasma cell in blood

10

Distribution of monoclonal proteins in MM

M protein found in serum or urine of 97% at time of dx

11

Myeloma clinical findings

Pathologic fractures

pancytopenias

renal failure

hyperviscosity

 

12

Myeloma causes increased infections due to:

- lack of effective antibodies

- decreased opsonization

- neutropenia from marrow myeloma

- chemotherapy

steroids-> immunosuppression 

neutropenia

13

Myeloma renal failure due to

1. myeloma kidney: light chains inhibit renal tubular function

2. amymoidosis: light chain deposits

3. uric acid and calcium deposits (hyper ca and hyper uric acid)

4. renal infiltrates by plasma cells

5. infections: pylenephritis, glomerulonephritis

 

14

Tx for myeloma

1. Bisphosphonates

- supportive and adjunctive therapy for MM

2. Immunomodulatory drugs

- thalidomide, lenalidomide

- disrupts cell-cell, vascular interaction, microenviroment and indirectly supresses neoplasm

3. Proeosome inhibitors

- Bortesomib

- potent, possible directed against nf-kb in myeloma cell

4. stem cell transplant

5. others- (ex. phenylalanine mustard, HSP90 inhibitors)

15

Waldenstroms macroblobulinemia

1. lymphoid-plasmacytoid cells in marrow and sometimes blood

2. clonal production of igM

3. IgM pentamers, large, in plasma lead to hyperviscosity

4. sypmptoms from hyperviscosity

- fatigue, malaise, SOB, neurologic, bleeding, headache, visual symptoms

5. No bone lesions

- early lymphocytoi-plasma cells dont made bone resorption factors

16

Excess light chian production leads to

1. hypogammaglobulinemia, dimished opsinization

2. neutropenia due to marrow failure/crowding out

3. chemotherapy induced neutropenia and immunosuppression

17

Lab changes seen in myeloma

1. hyperproteinemia, total gamma globulins , monclonal spike

2. abnormal monoclonal pattern on serum and urine immune electrophoreisis

3. Bence Jones proteinuria, from abnormal light chain production

4. Increased Calcium and uric acid

5. anemia na dother cytopenias