Multiple Myeloma Exam With Verified
Solutions
Multiple Myeloma is a malignancy of _________ cells
plasma
T or F: MM is the most common hematologic malignancy in the US.
False, 2nd most common after non-hodgkin's disease
Which ethnicity has a 2x incidence of MM?
African Americans
List Risk Factors for MM
Ionizing Radiation
-Atomic bomb survivors 5x increased risk
-radiologists
pesticides, nickel exposure, aromatic hydrocarbons
*MGUS*
-monoclonal gammopathy of undetermined significance
Herpes Virus 8 or HIV
Hereditary
- increased with at least 2 family members
Which precursor to MM is also a risk factor?
MGUS
-monoclonal gammopathy of undetermined significance
List Signs/Symptoms of MM
Bone pain/fractures
Hypercalcemia
Neurologic symptoms
-nerve compression, hyperviscosity (IgA)
Anemia
Bacterial Infections
-Depleted T lymphocytes and non-functional IgG
"Myeloma Kidney"
-50% patients have increased CrCl
-caused by hypercalcemia, hyper viscosity,hyperuricemia
List two complications of Myeloma
1. Bone disease
, -stimulated osteoclasts and bone breakdown
RANKL and inflammatory mediators upregulated
2. Angiogenisis: increase in blood vessel density can use PCLI is predict increased density
High plasma cell labeling index (PCLI)
Increased angiogenesis
-> increased blood thickness
List Diagnostic tests for MM
CBC with diff
CMP: Ca, SCr,BUN,LDH,albumin
Bone marrow biopsy
*B2-microglobulin (Ig heavy chain)*
MRI, bone scan
Serum Protein electrophoresis
*identify M spike-85% patients**
Which prognosis/risk cytogenetic mutation occurs in ~65% of MM patients?
chromosome 14 mutation which leads to Ig heavy chain translocation
List the disease progression of MM
Normal plasma cell
MGUS
(Monoclonal gammopathy of undetermined significance)
Smoldering/indolent myeloma
multiple myoloma
Which diagnostic criteria is used most commonly in active (symptomatic myeloma)?
Lytic bone lesions: parts of bone are punched out by cancer
CRAB criteria
What does CRAB stand for?
Calcium
Renal dysfunction
Anemia
Bone
Describe CRAB
Calcium (30%)
>11.5 mg/dl (normal 4.4-5.4)
causes volume depletion and dehydration
Solutions
Multiple Myeloma is a malignancy of _________ cells
plasma
T or F: MM is the most common hematologic malignancy in the US.
False, 2nd most common after non-hodgkin's disease
Which ethnicity has a 2x incidence of MM?
African Americans
List Risk Factors for MM
Ionizing Radiation
-Atomic bomb survivors 5x increased risk
-radiologists
pesticides, nickel exposure, aromatic hydrocarbons
*MGUS*
-monoclonal gammopathy of undetermined significance
Herpes Virus 8 or HIV
Hereditary
- increased with at least 2 family members
Which precursor to MM is also a risk factor?
MGUS
-monoclonal gammopathy of undetermined significance
List Signs/Symptoms of MM
Bone pain/fractures
Hypercalcemia
Neurologic symptoms
-nerve compression, hyperviscosity (IgA)
Anemia
Bacterial Infections
-Depleted T lymphocytes and non-functional IgG
"Myeloma Kidney"
-50% patients have increased CrCl
-caused by hypercalcemia, hyper viscosity,hyperuricemia
List two complications of Myeloma
1. Bone disease
, -stimulated osteoclasts and bone breakdown
RANKL and inflammatory mediators upregulated
2. Angiogenisis: increase in blood vessel density can use PCLI is predict increased density
High plasma cell labeling index (PCLI)
Increased angiogenesis
-> increased blood thickness
List Diagnostic tests for MM
CBC with diff
CMP: Ca, SCr,BUN,LDH,albumin
Bone marrow biopsy
*B2-microglobulin (Ig heavy chain)*
MRI, bone scan
Serum Protein electrophoresis
*identify M spike-85% patients**
Which prognosis/risk cytogenetic mutation occurs in ~65% of MM patients?
chromosome 14 mutation which leads to Ig heavy chain translocation
List the disease progression of MM
Normal plasma cell
MGUS
(Monoclonal gammopathy of undetermined significance)
Smoldering/indolent myeloma
multiple myoloma
Which diagnostic criteria is used most commonly in active (symptomatic myeloma)?
Lytic bone lesions: parts of bone are punched out by cancer
CRAB criteria
What does CRAB stand for?
Calcium
Renal dysfunction
Anemia
Bone
Describe CRAB
Calcium (30%)
>11.5 mg/dl (normal 4.4-5.4)
causes volume depletion and dehydration
