Term
| epidemiology of multiple myeloma |
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Definition
- slight male predominance
- blacks more than whites
- mean age: 65 yrs
- MGUS is predisposing factor
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Term
| Aside from multiple myeloma, what are the other plasma disorders |
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Definition
- smoldering MM
- MGUS
- solitary plasmacytoma
- Waldenstrom's macroglobulinemia
- amyloidosis
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Term
| clinical presentations of multiple myeloma |
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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
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Term
| criteria defining multiple myeloma |
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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
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Term
| Of the M protein in multiple myeloma, what kind of Ig do we normally see? |
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Definition
- IgG (major)
- IgA
- light chain only
- rare- IgD
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Term
| clonality of bone marrow plasma cells |
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Definition
- kappa/lambda staining normally in 2:1 ratio
- K:L 5:1 or higher (kappa)
- K:L 1:2 or lower (lambda)
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Term
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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
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Term
| poor prognostic factors of multiple myeloma |
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Definition
- elevated beta 2 microglobulin
- high plasma cell labeling index
- increase LDH
- plasmablastic morphology
- increase plasma cells in bone marrow
- deletion of chromosome 13
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Term
| classification of active multiple myeloma: high risk |
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Definition
- deletion of chromosome 13
- cytogenic hypodiploidy
- FISH
- deletion of 17p
- 4:14 translocation
- 14:16 translocation
- PCLI>3%
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Term
| classification of active multiple myeloma: standard risk |
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Definition
- hyperdiploid
- 11:14 translocation
- 6:14 translocation
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Term
| Durie salmon staging system |
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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
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Term
| Relation btw beta 2 microglobulin levels and survival months |
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Definition
| the more beta 2 microglobulin protein detected, there is a substantial decrease in survival time |
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Term
| international staging system for myeloma |
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Definition
- stage I- lower beta2 M and higher albumin (means liver can still make protein and have adequate nutrition)
- stage II- in btw
- stage III- beta 2 M is much higher
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Term
| role of thalidomide in tx of multiple myeloma |
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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 |
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Term
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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
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Term
| indications ofr bisphosphonates for multiple myeloma and adverse effects |
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Definition
- ex: Pamidronate, Zoledronic acid
- pts with documented bone disease
- CI: smoldering MM
- adverse effects
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Term
| adverse effects of bisphosphonates |
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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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