Myeloma

Question 1

What is Multiple Myeloma?

Answer 1

abnormal proliferation of plasma cells: plasma cells are unregulated in production of useless Ig that do not fight infection

Question 2

What type of Ig are produced in Multiple Myeloma?

Answer 2

Usually IgG or IgA

Question 3

What are the 2 most common causes of death in Multiple Myeloma?

Answer 3

Renal Failure and Infection

Question 4

What is the most common symptoms of Mulitple Myeloma?

Answer 4

Bone pain from pathologic fractures
-hypercalcemia common

Question 5

What are other common features of Multiple Myeloma?

Answer 5

Hyperuricemia: increased plasma cell turnover
Anemia: infiltration of BM
Renal failure: accumulation of Ig and Bence-jones protein

Question 6

What is the initial diagnostic test for Multiple Myeloma?

Answer 6

X-ray of affected bone: showing lytic (punched-out) lesions

Question 7

When is seen on Serum Protein Electrophoresis in Multiple Myeloma?

Answer 7

IgG (60%) or IgA (25%) spike of single type (clone)
15% have light chains or Bence-Jones protein only

Question 8

What lab value commonly results from Multiple Myeloma?

Answer 8

Hypercalcemia

Question 9

What is seen on Urine Immunoelectrophoresis in MM?

Answer 9

Bence-jones protein

Question 10

What levels correspond with severity of disease in MM?

Answer 10

Beta-2-microglobulin

Question 11

What is seen on Blood smear in MM?

Answer 11

Rouleaux

Question 12

What is seen on BM biopsy in MM?

Answer 12

> 10% plasma cells defines myeloma

Question 13

What happens to the anion gap in MM?

Answer 13

Decreased because IgG is Cationic: increases Cl and HCO3 levels decreasing the anion gap

Question 14

What causes the formation of Rouleaux in MM?

Answer 14

IgG paraprotein sticks to the RBC causing them to adhere to each other

Question 15

What is the single most accurate test for Myeloma?

Answer 15

BM biopsy

Question 16

When is treatment indicated for MM?

Answer 16

Plasma cells >60% in marrow or FLC ratio >100

Question 17

What is the best initial therapy for MM?

Answer 17

Dexamethasone + Lenalidomide or Bortezomib (or both)

Question 18

What drug is used in older patients for MM?

Answer 18

Melphalan

Question 19

What is the most effective therapy for MM for patients <70 ?

Answer 19

Autologous Bone marrow transplant with stem cell support

Question 20

What drugs used in MM can cause clotting?

Answer 20

Thalidomide and Lenalidomide

Question 21

What is given before therapy to avoid clotting from Thalidomide and Lenalidomide?

Answer 21

Prophylaxis

Question 22

What is the “CRAB” Pneumonic for MM?

Answer 22

Calcium High
Renal Failure
Anemia
Bone Lesion

Question 23

What is Monoclonal Gammopathy of Unknown Significance (MGUS)?

Answer 23

IgG or IgA spikes commonly in older patients with small # of plasma cells

Question 24

What correlates the risk of MGUS to myeloma?

Answer 24

The quanitity or amount of Ig in the Spike: more MGUS is more risk

Question 25

What is the treatment for MGUS?

Answer 25

no treatment

Question 26

What is Smoldering Myeloma?

Answer 26

10-60% plasma cells with an M-Spike on SPEP

Question 27

What lab abnormalities are seen in Smoldering Myeloma?

Answer 27

Elevated urine monoclonal protein and elevated FLC ratio -no hypercalcemia, renal failure, anemia or bone lesions

Question 28

What is the treatment for Smoldering Myeloma?

Answer 28

No specific treatment

Question 29

What is Waldenstrom Macroglobulinemia?

Answer 29

Overproduction of IgM from malignant B cells which leads to hyperviscosity

Question 30

How does Waldenstrom Macroglobulinemia commonly present?

Answer 30

Lethargy Blurry vision and vertigo Engorged blood vessels in the eye Mucosal bleeding Raynaud Phenomenon

Question 31

What is the best initial therapy for Waldenstrom Macroglobulinemia?

Answer 31

Plasmapheresis

Question 32

How is Waldenstrom macroglobulinemia treated long term?

Answer 32

Rituximab or Prednisone Cyclophsophamide Bortezomib or Lenalidomide