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ICM- Hematology and Oncology
Multiple Myeloma and other Plasma cell disorders (T Pierce)
17
Medical
Professional
11/30/2009

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Cards

Term
epidemiology of multiple myeloma
Definition
  • slight male predominance
  • blacks more than whites
  • mean age: 65 yrs
  • MGUS is predisposing factor
Term
Aside from multiple myeloma, what are the other plasma disorders
Definition
  • smoldering MM
  • MGUS
  • solitary plasmacytoma
  • Waldenstrom's macroglobulinemia
  • amyloidosis
Term
clinical presentations of multiple myeloma
Definition
  • monoclonal (M) proteins
    • SPEP
    • SPEP + IFE
    • SPEP + IFE + either FLC or UPEP/UIFE
  • lytic bone lesions
  • increase plasma cells in bone marrow
  • anemia (normocytic normochromic)
  • more rare
    • hypercalcemia
    • renal failure, serum creatinine >2
Term
criteria defining multiple myeloma
Definition
  • evidence of monoclonal plasma cell disorder (M protein, clonal bone marrow plasma cells)
  • plus one of the following
    • renal failure
    • lytic bone lesions
    • anemia
    • hypercalcemia
Term
Of the M protein in multiple myeloma, what kind of Ig do we normally see?
Definition
  • IgG (major)
  • IgA
  • light chain only
  • rare- IgD
Term
clonality of bone marrow plasma cells
Definition
  • kappa/lambda staining normally in 2:1 ratio
  • K:L 5:1 or higher (kappa)
  • K:L 1:2 or lower (lambda)
Term
dx of multiple myeloma
Definition
  • CBC
  • SPEP (alone is inadequate)
    • some myeloma clone secrete only light chains
  • UPEP
  • chemistries including creatinine and BUN
  • calcium
  • beta 2 microglobulin
  • skeletal survey (bone scans can miss lytic lesions)
  • bone marrow aspirate and biopsy
  • plasma cell labeling index measures of proportions of plasma cells actively synthesizing DNA and may provide useful prognostic info
Term
poor prognostic factors of multiple myeloma
Definition
  • elevated beta 2 microglobulin
  • high plasma cell labeling index
  • increase LDH
  • plasmablastic morphology
  • increase plasma cells in bone marrow
  • deletion of chromosome 13
Term
classification of active multiple myeloma: high risk
Definition
  • deletion of chromosome 13
  • cytogenic hypodiploidy
  • FISH
    • deletion of 17p
    • 4:14 translocation
    • 14:16 translocation
  • PCLI>3%
Term
classification of active multiple myeloma: standard risk
Definition
  • hyperdiploid
  • 11:14 translocation
  • 6:14 translocation
Term
Durie salmon staging system
Definition
  • I (lower mass)
    • higher Hb
    • serum calcium lower
    • normal or solitary plasmacytoma
    • IgG lower
    • IgA lower
    • low Bence Jones protein
  • III (higher mass)
    • anemia
    • hypercalcemia
    • multiple lytic bone lesions
    • higher IgG
    • higher IgA
    • higher Bence Jones protein
Term
Relation btw beta 2 microglobulin levels and survival months
Definition
the more beta 2 microglobulin protein detected, there is a substantial decrease in survival time
Term
international staging system for myeloma
Definition
  • stage I- lower beta2 M and higher albumin (means liver can still make protein and have adequate nutrition)
    • survival: 5 yrs
  • stage II- in btw
    • survival: 44 months
  • stage III- beta 2 M is much higher
    • survival: 2.5 yrs

 

Term
role of thalidomide in tx of multiple myeloma
Definition
  • shows increase in survival rates
  • 50% response rate with combine with dex
  • add alkylators to thal/dex, you get to 70% response

median response duration of one yr

Term
tx of multiple myeloma
Definition
  • chemotherapy
    • alkylating agents, steroids, thalidomide
  • radiation of severe areas of bone disease
  • bisphosphonates (reduce risk of pathologic fracture)
  • supportive care including pain meds, antibiotics
  • close monitoring of SPEP, renal function, calcium
Term
indications ofr bisphosphonates for multiple myeloma and adverse effects
Definition
  • ex: Pamidronate, Zoledronic acid
  • pts with documented bone disease
  • CI: smoldering MM
  • adverse effects
Term
adverse effects of bisphosphonates
Definition

stop after 2 yrs if stable diserase and decrease frequency every 3 months if active disease

  • pamidronate (preferred)
  • focal collapsing segmental glomerulosclerosis
  • azotemia often preceded by albuminuria
  • zoledronic acid
  • tubular dysfunction (ex: interstitial nephritis)
  • renal failure (less likely albuminuria)
  • osteonecrosis of jaw
  • tooth, jaw pain
  • CI: invasive dental procedure
  • make oral surgeon/dentist aware
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