Flashcards in Plasma cell dyscrasias Deck (60):
What is the primary treatment for polycythemia vera?
How do you differentiate between essential thrombocytosis and 51 syndrome?
5q syndrome will have myelodysplasia
What is the cause of multiple myeloma?
Plasma cell overgrowth and produce M protein
Who usually gets multiple myeloma?
What are the two bits of the light chain abs?
Kappa and lambda
What are the Igs that are overproduced in multiple myeloma?
IgG, IgA, or IgE
How do you write down diagnosis for multiple myeloma?
Ab type + light chain type
(e.g. IgG kappa)
What is MGUS?
Precancerous condition, where there is an idiopathic overproduction of Igs
What is the chance of developing multiple myeloma with MGUS?
1% per year
What are the symptoms of MGUS?
Lytic bone lesions on bone *survey* = ?
What are the specific ssx of myeloma?
What are the criteria for digasnosis for multiple myelioma
1. Urine or serum abnormal monoclonal protein overproduction
2. End organ damage
3. presence of plasma cells in plasma or bone marrow
What are the four criteria for end organ damage with multiple myeloma?
Lytic bone lesions
What are smoldering myelomas? What is the criteria for diagnosis?
Serum monoclonal protein >3 g/dL or >10%
No end organ damage
What are the two indicators used to stage multiple myeloma?
B2M and serum albumin
Stage I multiple myeloma = ?
B2M 3.5 g/dL
Stage III multiple myeloma = ?
B2M >5.5 mg/L
Is multiple myeloma curable?
What are the median survival times for Stage I-III multiple myeloma?
I = 62 months
II = 44 months
III = 29 months
True or false: multiple myeloma can be caused by translocation of genes
What is the common translocation that can cause multiple myeloma?
What is the treatment for smoldering multiple myeloma?
What is the treatment for active multiple myeloma?
(auto bone marrow transplant)
What is the basis for autogenic transplant for multiple myeloma? Is this curative?
Hope to get rid of the bad plasma cells, but this is still not curative
When is radiation used in multiple myeloma treatment?
Lytic bone lesions
What is monitored during smoldering myeloma?
Annual bone surveys
What is the basis for choosing drugs in multiple myeloma?
Based on risk and eligibility of stem cell transplant
What is the drug that is used to treat multiple myeloma?
What drug should you avoid giving multiple myeloma pts if they're transplant eligible?
What is the goal of stem cell transplants with multiple myeloma?
Prolongation in survival
What are the two maintenance therapies after autotransplant in multiple myeloma pts?
What is plasmacytoma?
Bone or soft tissue mass that does not produce Igs
What are the four bones (in descending order) where plasmacytomas are found?
Which is more likely, a bone plasmacytoma or soft tissue?
How do you diagnose plasmacytoma?
Biopsy proven solitary lesion of bone or soft tissue clonal plasma cells
Normal skeletal survey
What is the treatment for plasmacytomas?
radiation / surgery
What is the prognosis of bone plasmacytomas?
20% disease free at 10 years
Which has a better prognosis: bone plasmacytomas, or extramedullary plasmacytomas? Why?
Extramedullary since it is more likely to be localized
What is amyloidosis?
Protein conformational disorder associated with clonal plasma cell dyscrasia, causing deposition of fragments
True or false: there is a good correlation between the amount of amyloid and the degree of impairment of organ function
What are the usual organs usually affected by amyloidosis?
What percent of pts with myeloma have concurrent amyloidosis?
What is the stain used for definitive diagnosis for amyloidosis?
Congo red with red-green birefringence under polarized light
What are the two screens for amyloidosis?
MPEV + urine IF and serum light chain
What are the tissues that are sampled for amyloid in primary amyloidosis?
Bone marrow (50% sens) or fat pad (70% sens)
What is the most important complication of primary amyloidosis?
What are the poor prognostic factors for primary amyloidosis? (3)
-Associated with multiple myeloma
What is the treatment for primary amyloidosis?
No optimal treatment
Try to retard further deposition of amyloid
What is Waldenstrom's macroglobulinemia?
Excess IgM in bone blood
What is the difference between IgM producing multiple myeloma and Waldenstrom's?
Waldenstrom's has a lymphoma component
What are the complication of waldenstrom's?
What is the coomb's test result with Waldenstrom's?
How do you diagnose Waldenstrom's?
IgM monoclonal gammopathy
Bone marrow > 10% monoclonal lymphocytes and plasma cell differentiation
What is the treatment for waldenstrom's?
Asymptomatic = observe
Symptomatic = chemo/plasmapheresis
How long does it take for waldenstrom's take to progress?
True or false: Waldenstrom's is incurable
What are the presenting ssx of plasmacytoma?
Localized pain (especially if found in bone)
What is the threshold of serum monoclonal antibody to have a diagnosis of multiple myeloma, as opposed to MGUS?
>3g and/or 10-60% bone marrow clonal plasma cells