Myeloma and Myelodysplastic Syndromes Flashcards Preview

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Flashcards in Myeloma and Myelodysplastic Syndromes Deck (17):
1

Myeloma

A cancer of transformed plasma cells (terminally differentiated B cells) that secrete Ig and are the effectors cells of the specific humoral immune response

2

Diagnosis of Myeloma

Clonal plasma cells >10% on bone marrow biopsy or (in any quantity) in a biopsy from other tissues (plasmacytoma)

A monoclonal protein (Myeloma protein) in either serum or urine (except in cases of true non-secretory myeloma)

Evidence of end-organ damage felt related to the plasma cell disorder ("CRAB"):
HyperCalcemia (corrected calcium >2.75 mmol/l, >11 mg/dL)
Renal insufficiency attributable to myeloma
Anemia (hemoglobin <10 g/dl)
Bone lesions (lytic lesions or osteoporosis with compression fractures)

3

Asymptomatic/smoldering myeloma:

Serum M protein >30 g/l (3 g/dL) and/or
Clonal plasma cells >10% on bone marrow biopsy and
No myeloma-related organ or tissue impairment

4

Monoclonal gammopathy of undetermined significance (MGUS):

Serum paraprotein <30 g/l (3 g/dL) and
Clonal plasma cells <10% on bone marrow biopsy and
No myeloma-related organ or tissue impairment or a related B-cell lymphoproliferative disorder

5

Durie Salmon

stage I: all of
Hb > 10g/dL
normal calcium
Skeletal survey: normal or single plasmacytoma or osteoporosis
Serum paraprotein level < 5 g/dL if IgG, < 3 g/dL if IgA
Urinary light chain excretion < 4 g/24h

stage II: fulfilling the criteria of neither I nor III

stage III: one or more of
Hb < 8.5g/dL
high calcium > 12 mg/dL
Skeletal survey: Three or more lytic bone lesions
Serum paraprotein > 7g/dL if IgG, > 5 g/dL if IgA
Urinary light chain excretion > 12g/24h


A: serum creatinine < 2 mg/dL (< 177 μmol/L)
B: serum creatinine > 2 mg/dL (> 177 μmol/L)

6

Cells: Myeloma

Bizarre cells, which are multinucleated.

- Mott cells, containing multiple clustered cytoplasmic droplets or other inclusions (sometimes confused with auer rods, commonly seen in myeloid blasts)

- Flame cells, having a fiery red cytoplasm

7

Induction Therapy Pre SCT: Myeloma

bortezomib based regimens,
lenalidomide–dexamethasone

8

No SCT: Myeloma

bortezomib, melphalan, and prednisone

9

Immunphenotype: Myeloma

• Positive: CD38, CD138, CD56/58, monotypic cytoplasmic Ig, LC restricted
• Negative: CD19, CD20, surface Ig

10

Refractory Anaemia

Blood: Anaemia, no blasts
BM: Erythroid Dysplasia with <5% blasts

11

Refractory Anaemia with ring sideroblasts

Blood: anaemia, no blasts

BM: Erythroid dysplasia with >15% ring suderoblasts

12

Refractory cytopenia with multilineage dysplasia

Blood: Cytopenia in >/= 2 cell lines

BM: Dysplasia in >10% cells in >/=2 lines

13

Refractory cytopenia with multilineage dysplasia
and Ring Sideroblasts

Blood: Cytopenia in >/= 2 cell lines

BM: Dysplasia in >10% cells in >/=2 lines and >15% ring sideroblasts

14

Refractory anaemia with excess blasts 1

Blood: Cytopenias, <5% blasts, no auer rods

BM: Dysplasias, 5-9% blasts

15

Refractory anaemia with excess blasts 2

Blood: Cytopenias or 5-19% blasts or auer rods

BM: Dysplasias or 10-19% blasts or Auer rods

16

MDS with 5q deletion

Blood: Anaeamia with notmal or increased platelets

BM:Megacaryocytes with hypolobulated nuclei and <5% blasts

17

Myelodysplasia syndrme unclassified

Blood: Comples-cytopenias, no blases, no auer rods

BM: myeloid or megacaryocyte dysplasia, <5% blasts