Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Malignant haematology > Multiple myeloma > Flashcards

Multiple myeloma Flashcards

(45 cards)

Start Studying
1
Q

Who gets myeloma

A

Elderly - median age presentation is 70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is multiple myeloa

A

Plasma cell proliferation haem malignancy from mutation as B lymphocytes -> mature plasma cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clinical features of MM

A

CRABBI
Calcium high
Renal impairment
Anaemia
Bleeding - TP
Bones Pain + fractures
Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes hypercalcemia in myeloma

A

Increased osteoclast bone resorption due to cytokines from myeloma cells
Renaldysfuctnion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hypercalcemia features

A

Constipation, nausea, anorexia, confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Renal problems in myeloma cause

A

Monoclonal productuon IgGs -> light chain deposition in renal tubules
Renal damage -> dehydration and thirst
also amyloidosis, nephrocalcinosis, nephrolithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What causes bone pain and pathological fractures in myeloma

A

Bone marrow infiltration by plasma cells and cytokine mediated osteoclast activity -> lytci bone lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Other features of myeloma not pneumonic

A

Amyloidosis eg macroglossia
Carpal tunnel
neuropathy
Hyperviscosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How assess for myeloma in over 60s

A

FBC, calcium, plasma viscosity or ESR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When assess for myeloma

A

General screen - >60, persistent bone pain esp back pain or unexplained fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When urgent electrophoresis for myeloma

A

> 60
Hypercalcemia or leukopenia
Presentation suggests myeloma
OR
pllasma viscosity or ESR and presentation consistent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How investigate for myeloma initially

A

FBC, calcium (bone profile), plasma viscoity, ESR
Consider - blood silm, U+Es
Urgent plasma electrophoresis and bence jones protein urine test within 48 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When refer for myeloma

A

When electrophoresis/bence jones test +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Blood film in myeloma

A

Rouleaux formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What see on electrophoresis in myeloma

A

IgA/IgA proteins in serum, bence jones in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Further investigations myleoma

A

Bone marrow aspiration - plasma cells raised
Skeletal survey
Whole body MRI
X rays -> rain drop skull

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What see on X ray in myeloma

A

Rain drop skull - splashing = dark spots random
V SIMILAR TO PEPPER POT SKULL IN PRIMARY HYPERPARATHYROIDISM
Look at x rays to differntiate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Diagnostic criteria for myeloma

A

1 - clonal bone marrow plasma cells >10% OR biopsy proven plasmacytoma
2 - one or more myeloma defining events:
->60% plasma cells in marrow
-Light chain ration >100
2 > focal lesions on MRI >5mm
-Hypercalcemia >2.75mmol/l or o.25 over normal
-Renal insuff - >177 umol/l creatinine or clearance <40ml/min
-Anaemia <100g/l or 20 below normal
-1 or more lytic bone lesion on X ray, CT or PET/CT >5mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why is allogeneic stem cell transplant not used in myeloma

Study These Flashcards
A

Hgh overall mortatlity and GvHD

20
Q

What is autologous HSCT

Study These Flashcards
A

Removal of paitents own stem cells prior to chemo, replaced afterwards
Porlongs event free and overall survival

21
Q

Induction regime myeloma

Study These Flashcards
A

Targeted drugs eg thalidomide, lenalidomide, bortezomib daratumumab
Chemo eg cyclophosphamide or melphalan
Steroids eg pred or dex

22
Q

Complications fo myeloma

Study These Flashcards
A

Pain
Pathological fracture
Infection
VTE
Fatigeu

23
Q

Supportive managmenet myeloma

Study These Flashcards
A

Analgesia
Zoledronic acid = manage osteoporosis
Infection - flu vaccine, IgG repllacemetn
VTE prophylaxis
Fatigue - consider EPO

24
Q

What is staging of myeloma based on

Study These Flashcards
A

B2 microglobulin
Albuin levels

25
Stage I -III myeloma
I - B2 microglobulon <3.5mg/l Albumin >35g/L II - not either III - B2 microglobulin >5.5mg/l
26
Poor prognosis cytogenetic abnormalities for myeloma
t4:14, 14:16, 14:20 del 17p and gain 1q
27
How measure performance status
Eastern Cooperative Oncology Group (ECOG) scale or the Karnofsky Performance Scale (KPS)
28
Poor prognostic factors
Specific cytogenetics Performance status Age and comborbities Response to treatmnet initially (Complete, v good partial = better) Albumin Peripheral blood plasma cells (abnormal to see out of marrow) LDH level Serum B2 micoglobulin (high = bad) Eligible for autologous stem cell transplantation Minimal residual disease
29
What assess after treatment for myeloma
MRD assess for residual myeloma cells after treatment Negativity ass w prolonged progression free survival and overall survival
30
Prognostic models myeloma
Revised international staging system - ISS stafe, risk cytogenetics, LDH level - I-III Myeloma risk stratification -
31
Risks for myeloma
Radiation, agriculture, metals, rubber, chemicals and combustion fuel prodyucts FH, genetics implicated Dont know cause
32
What is myelomas premalignant phase
Monoclonal gammopathy of uncertain significance
33
Myeloma cells on blood film
Perinuclear halo Large cells Eccentric nucelus Large amounts ble cytoplasms
34
What is myeloma characterised by
Monoclonal protein in serum/urine Lytic bone lesions Excess plasma cell sin bone marrow
35
What is electrophoresis testing for
The 'antibodies' OR only light chain proteins released by myelomas (cancerous plasma B cells) causing the symptoms
36
What are lytic lesions
Destruction of bone tissue around myeloma tumours
37
What does M protein cause
Neuropathy and renal compromise
38
Renal damage mechainsm myeloma
Light cahins filtered into glomerulus- not all light chains reabsorbed -> loop of henle -> jelly/cast formation in loop of henle destroying a nephron -> casts
39
Preventing renal damage in myeloma
Early diagnosis High fluid intake at least 3 litres/day Bring down calcium Potentially nephrotoxic drugs eg aminoglycosides, NSAIDs avoided, monitor bisphosphonates closely Treat infection
40
Complication of pathological fractures in back
sPINAL CORD compression
41
Bone disease in myeloma pathology
Increased osteoclast bone resorption due to cytokines from myeloma cells -> increased bone resorption, hypercalcemia, decreased osteoblastic activity and impaored glomerual filtration
42
Bone disease and hypercalcemia emergency treatment
IV fluids, steroids, bisphosphonates
43
Benefits of bisphosphonates in myeloma
Prevent vertebral fractures amerlioration of pain Prolong PFS, OS reduction in m non vertebral fractures and hypercalcemia
44
Can you cure multiple myeloma
No
45
What infections are myeloma patients particuarly at risk of
Strep pneumoniae H.influenzae VZV recurrence shingles

Malignant haematology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions