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Questions and Answers
What are the three diagnostic criteria for multiple myeloma?
What are the three diagnostic criteria for multiple myeloma?
Monoclonal protein (M-protein) in blood or urine, Bone marrow plasma cells ≥ 10%, and Evidence of end-organ damage (e.g., anemia, bone lesions, hypercalcemia, kidney disease).
What is the main difference between the International Staging System (ISS) and the Revised ISS (R-ISS)?
What is the main difference between the International Staging System (ISS) and the Revised ISS (R-ISS)?
The R-ISS incorporates lactate dehydrogenase (LDH) levels and high-risk chromosomal abnormalities, in addition to β2-microglobulin and albumin levels.
What is the role of maintenance therapy in multiple myeloma treatment?
What is the role of maintenance therapy in multiple myeloma treatment?
To prolong remission.
What is the mechanism of action of daratumumab in multiple myeloma treatment?
What is the mechanism of action of daratumumab in multiple myeloma treatment?
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What are the three main aspects of symptom management in multiple myeloma?
What are the three main aspects of symptom management in multiple myeloma?
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How is relapsed disease defined in multiple myeloma?
How is relapsed disease defined in multiple myeloma?
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What is the primary goal of autologous stem cell transplant (ASCT) in multiple myeloma treatment?
What is the primary goal of autologous stem cell transplant (ASCT) in multiple myeloma treatment?
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What is the primary risk associated with allogenic stem cell transplant in multiple myeloma treatment?
What is the primary risk associated with allogenic stem cell transplant in multiple myeloma treatment?
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What is the primary characteristic of multiple myeloma, and what is another name for this disease?
What is the primary characteristic of multiple myeloma, and what is another name for this disease?
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What are the three main risk factors for developing multiple myeloma?
What are the three main risk factors for developing multiple myeloma?
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What are the common symptoms of multiple myeloma?
What are the common symptoms of multiple myeloma?
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What are the diagnostic tests used to diagnose multiple myeloma?
What are the diagnostic tests used to diagnose multiple myeloma?
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How is multiple myeloma staged, and what is the significance of staging?
How is multiple myeloma staged, and what is the significance of staging?
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What are the common complications of multiple myeloma?
What are the common complications of multiple myeloma?
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What are the treatment options for multiple myeloma?
What are the treatment options for multiple myeloma?
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What is the prognosis for multiple myeloma, and how does it vary by stage?
What is the prognosis for multiple myeloma, and how does it vary by stage?
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Study Notes
Diagnosis
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Diagnostic criteria:
- Monoclonal protein (M-protein) in blood or urine
- Bone marrow plasma cells ≥ 10%
- Evidence of end-organ damage (e.g., anemia, bone lesions, hypercalcemia, kidney disease)
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Diagnostic tests:
- Blood tests: complete blood count (CBC), serum protein electrophoresis (SPEP), serum free light chain (SFLC) assay
- Urine tests: urine protein electrophoresis (UPEP), urine SFLC assay
- Bone marrow biopsy and aspirate
- Imaging studies: skeletal survey, PET/CT, MRI
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Staging systems:
- International Staging System (ISS): based on β2-microglobulin and albumin levels
- Revised ISS (R-ISS): incorporates lactate dehydrogenase (LDH) levels and high-risk chromosomal abnormalities
Treatment Options
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Induction therapy:
- Combination of chemotherapy, immunomodulatory agents, and proteasome inhibitors
- Examples: VRd (bortezomib, lenalidomide, dexamethasone), KRd (carfilzomib, lenalidomide, dexamethasone)
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Maintenance therapy:
- Lenalidomide or bortezomib to prolong remission
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Targeted therapies:
- Daratumumab (anti-CD38 monoclonal antibody)
- Elotuzumab (anti-SLAMF7 monoclonal antibody)
- Carfilzomib (proteasome inhibitor)
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Supportive care:
- Bisphosphonates for bone disease
- Erythropoietin for anemia
Symptom Management
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Pain management:
- Opioids, NSAIDs, and bisphosphonates
- Radiation therapy for bone pain
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Anemia management:
- Erythropoietin, iron supplements, and transfusions
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Bone disease management:
- Bisphosphonates, denosumab, and kyphoplasty
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Infection management:
- Antibiotics and antiviral medications
- Vaccination against pneumococcal and influenza infections
Relapsed/Refractory Disease
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Definition:
- Relapsed: disease progression after initial response
- Refractory: disease progression during or within 60 days of treatment
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Treatment options:
- Re-treatment with previous regimens
- Alternative regimens (e.g., pomalidomide, ixazomib)
- Clinical trials
Stem Cell Transplant
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Autologous stem cell transplant (ASCT):
- High-dose chemotherapy followed by infusion of patient's own stem cells
- Improves response rates and prolongs progression-free survival
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Allogenic stem cell transplant:
- High-dose chemotherapy followed by infusion of donor stem cells
- May offer curative potential, but associated with higher risk of graft-versus-host disease (GVHD)
Diagnosis
- Monoclonal protein (M-protein) is present in blood or urine
- At least 10% of bone marrow cells are plasma cells
- Evidence of end-organ damage, such as anemia, bone lesions, hypercalcemia, or kidney disease, is present
Diagnostic Tests
- Complete blood count (CBC) and serum protein electrophoresis (SPEP) are performed on blood samples
- Urine protein electrophoresis (UPEP) and urine serum free light chain (SFLC) assay are performed on urine samples
- Bone marrow biopsy and aspirate are performed to examine bone marrow cells
- Imaging studies, such as skeletal survey, PET/CT, and MRI, are used to visualize the body
Staging Systems
- International Staging System (ISS) is based on β2-microglobulin and albumin levels
- Revised ISS (R-ISS) incorporates lactate dehydrogenase (LDH) levels and high-risk chromosomal abnormalities
Treatment Options
- Induction therapy combines chemotherapy, immunomodulatory agents, and proteasome inhibitors
- Examples of induction therapy regimens include VRd and KRd
- Maintenance therapy uses lenalidomide or bortezomib to prolong remission
- Targeted therapies include daratumumab, elotuzumab, and carfilzomib
- Supportive care involves bisphosphonates, erythropoietin, and transfusions
Symptom Management
- Pain management involves opioids, NSAIDs, bisphosphonates, and radiation therapy
- Anemia management involves erythropoietin, iron supplements, and transfusions
- Bone disease management involves bisphosphonates, denosumab, and kyphoplasty
- Infection management involves antibiotics, antiviral medications, and vaccination against pneumococcal and influenza infections
Relapsed/Refractory Disease
- Relapsed disease is defined as disease progression after initial response
- Refractory disease is defined as disease progression during or within 60 days of treatment
- Treatment options for relapsed/refractory disease include re-treatment with previous regimens, alternative regimens, and clinical trials
Stem Cell Transplant
- Autologous stem cell transplant (ASCT) involves high-dose chemotherapy followed by infusion of patient's own stem cells
- Allogenic stem cell transplant involves high-dose chemotherapy followed by infusion of donor stem cells
Definition and Overview
- Multiple myeloma is a type of cancer that affects the plasma cells in the bone marrow, characterized by abnormal proliferation of plasma cells.
- It is also known as Kahler's disease or myelomatosis.
Causes and Risk Factors
- Age is a significant risk factor, especially after 65.
- Having a family member with multiple myeloma increases the risk of developing the disease.
- Exposure to high levels of radiation and certain chemicals, such as benzene, is a risk factor.
- African Americans are more likely to develop multiple myeloma.
Symptoms
- Bone pain, especially in the back, hips, or ribs, is a common symptom.
- Fatigue, weakness, and recurring infections are also common symptoms.
- Anemia, characterized by low red blood cell count, is often present.
- Hypercalcemia, or high calcium levels, is another common symptom.
- Kidney problems are also a common symptom.
Diagnosis
- Complete blood count (CBC), blood chemistry tests, and serum protein electrophoresis (SPEP) are used in blood tests to diagnose multiple myeloma.
- Urine protein electrophoresis (UPEP) is used in urine tests to diagnose multiple myeloma.
- Bone marrow biopsy is used to examine bone marrow cells.
- Imaging tests, such as X-rays, CT scans, MRI scans, and PET scans, are used to diagnose multiple myeloma.
Staging and Prognosis
- Multiple myeloma is staged based on the severity of the disease, with Stage I being the least severe and Stage III being the most severe.
- Stage I has a 5-year survival rate of 62%, Stage II has a 5-year survival rate of 45%, and Stage III has a 5-year survival rate of 29%.
Treatment
- Chemotherapy, targeted therapy, and immunotherapy are used to kill cancer cells and manage symptoms.
- Stem cell transplantation is used to replace bone marrow with healthy stem cells.
- Supportive care is used to manage symptoms and side effects.
Complications
- Bone damage, including osteoporosis, fractures, and bone deformities, is a common complication.
- Kidney damage, including kidney failure and chronic kidney disease, is a common complication.
- Infections, including recurrent infections and sepsis, are a common complication.
- Anemia, characterized by low red blood cell count, is a common complication.
- Hypercalcemia, or high calcium levels, is a common complication.
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Description
Diagnosing multiple myeloma involves identifying monoclonal protein in blood or urine, bone marrow plasma cells, and evidence of end-organ damage. Various tests are used to confirm the diagnosis.
