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Questions and Answers
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)?
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?
To prolong remission.
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?
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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?
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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?
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What are the three main risk factors for developing multiple myeloma?
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What are the common symptoms of multiple myeloma?
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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?
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What are the common complications of multiple myeloma?
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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?
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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
-
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
-
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.
