Flashcards in Multiple Myeloma Deck (27):
Multiple myeloma Patients usually present with?
Monoclonal proliferation (M-spike)
Bone clinic lesions
Common chromosome affected in multiple myeloma patients? How is it affected?
13. Deletions and translocations
Typical patient affected by multiple myeloma?
70-year-old black male
Growth of multiple myeloma cells are due to induction of what cytokines?
IL –6, insulin like growth factor, VEGF
The bone lesions of myeloma are caused by?
1. Proliferation of tumor cells
2. Activation of osteoclasts
3. Suppression of osteoblast
Why use plain film over radioisotopic bone scan for multiple myeloma?
Rarely associated with osteoblastic new bone formation, so decreased uptake of radio isotopes
Localized bone lesions multiple myeloma may lead to palpable masses on what bones? And collapse of what?
Skull, clavicles, sternum.
Collapse of vertebrae leading to spinal cord compression
Most common infections of multiple myeloma patients?
Pneumonias and pyelonephritis.
Due to Strep pneumonia, Staph aureus, Klebsiella, E. coli, and other gram-negative organisms in the urinary tract
Causes of increased susceptibility to infection multiple myeloma?
1. Diffuse hypogammaglobulinemia
2 CD4 cells may be decreased
3. Granulocyte lysozyme content is low
4. Treatment if myeloma with steroids
Factors contributing to renal failure?
Key: Excretion of light chains (Bence-Jones)
2. Amyloid deposits
6. Contrast dye for imaging
7. Bisphosphonate use
Earliest manifestation of tubular damage of the kidney in multiple myeloma?
Adult Fanconi syndrome
1. loss of glucose and amino acids in urine
2. kidney can't acidify urine (RTA)
Why do patients have a decreased anion gap in multiple myeloma? Often accompanied with?
M component is catatonic, resulting in retention of chloride. HypoNa.
Anion gap is Na - Cl - HCO3
Why do patients with multiple myeloma have normocytic anemia?
1. Replacement of normal marrow with expanding tumor
2. Inhibition of hematopoiesis by factors made by the tumor
3. Reduce production erythropoietin by the kidney
Why might a patient with multiple myeloma have clotting abnormalities?
Interaction of the M component but clotting factors I, II, V, VII, VIII
Why might a patient with multiple myeloma get Raynaud's phenomenon?
M component forms cryo globulins
Causes of neuro symptoms in multiple myeloma?
1. Hypocalcemia (lethargy weakness, depression, confusion)
2 hyperviscosity (headache, fatigue, retinopathy)
3. Bone damage (Cord compression, radicular pain, loss of bowel and bladder control)
4. Infiltration of peripheral nerves amyloid (carpal tunnel syndrome, polyneuropathy)
Classic triad of multiple myeloma?
1. Marrow plasmacytosis
2. Lytic bone lesions
3. Serum/urine M-component
Therapy for patients with MGUS?
Elevated labs in multiple myeloma?
Calcium, urea nitrogen, creatinine, uric acid
To quantify Bence-Jones protein excretion need?
24 hour urine specimen
Alkaline phosphate level in multiple myeloma?
Normal (no osteoblast activity)
Which type of Bence-Jones protein is worse?
Lambda chains are more likely to cause renal damage and form amyloid than kappa chains
Single most powerful predictor of survival in multiple myeloma?
Therapy that achieves close to 100% response rate?
Lenalidomide, bortezomib, dexamethasone
Thalidomide mechanism of action?