Plasma Cell Myeloma (Multiple Myeloma) - Pathophysiology 370

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Pathophysiology
Chapter 11
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1

Which type of people does PCM affect exclusively? and what age?

adults > 40 years old

2

What is the median age at presentation for PCM?

> 65 years old

3

What is PCM described as?

Malignant disorder of mature, antibody-secreting B lymphocytes (aka plasma cells)

4

What do malignant plasma cells invade and what do they do?

Invade the bone and form multiple tumor sites

5

What other tissues may malignant plasma cells target?

lymph nodes

liver

spleen

kidney

6

What abnormalities are commonly found in PCM?

chromosome structure and number

7

What kind of clone do malignant plasma cells belong to?

single clone

8

What do single clones produce? and where do they accumulate?

excessive amounts of identical monoclonal antibodies that accumulate in the blood

9

What can detect the monoclonal antibodies?

serum protein electrophoresis

10

How do Bence Jones protein form? and where do they accumulate?

malignant plasm cells produce light chain antibody fragments that accumulate in the blood and urine

11

What does a large amount of one type of antibody form in PCM?

a characteristic spike

12

What does Bence Jones help to confirm?

diagnosis for PCM

13

What happens when Bence Jones protein accumulates in the kidneys?

it causes damage to the kidneys

14

Where do malignant plasma cells tend to accumulate? and what do they produce?

in the bone and produce bone lesions

15

Are pathologic fractures common in PCM?

yes

16

What are most clinical manifestations of PCM caused by?

bone and renal damage

17

What is the diagnosis of PCM based off?

monoclonal antibody peak

Bence Jones protein

Hypercalcemia

Evidence of bone lesions

18

What is the minimum percentage range of plasma cells that need to be found in the bone marrow to confirm diagnosis of PCM?

10% to 15%

19

What is the percentage range that plasma cells occupy in the bone marrow?

30% to 95%

20

What is the onset for PCM?

slow and insidious

21

What is monoclonal gammopathy of undetermined significance?

malignant gammopathy of undetermined significance

a premalignant stage in some people with excess production of monoclonal antibodies but no bone lesions or Bence Jones protein in the urine

22

At MGUS stage, what percentage of people progress to a malignant disorder?

25%

23

Do people at the MGUS stage remain symptomatic or asymptomatic?

asymptomatic

24

How long can people at the MGUS stage remain asymptomatic? And how many years?

until the disease is fairly advanced and for many years

25

What needs to be found in the asymptomatic stage on a routine exam to diagnose PCM?

protein in urine

high serum calcium levels

26

What is the first symptom of PCM?

bone pain

27

What are the bone depression indicators of PCM?

anemia

recurrent infections

bleeding tendencies

28

What is the percentage of patients with renal insufficiency in PCM?

approximately 50%

29

What combination of factors lead to renal insufficiency?

hyperproteinemia

Bence Jones protein

hypercalcemia

culminates with end-stage renal disease

30

What is found on a bone x-ray to confirm diagnosis of PCM? And where in the body can they be seen?

a honey comb appearance in the pelvis, ribs, spine and skull

31

What kind of trauma can cause fractures?

minimal trauma

32

What are the type of fractures with an unknown cause called that can be occur in PCM?

pathologic fractures

33

How do antineoplastic agents treat PCM?

induce and maintain remission in plasma and proliferation

34

What is the best chemotherapy treatment for PCM?

It has not been determined yet

35

What kind of treatment for PCM is becoming more common?

high dose chemotherapy followed by allogenic bone marrow transplant

36

What is the optimal initial treatment for PCM?

Autologous stem cell transplant

37

What treatment is used for renal disfunction in PCM?

pharmacologic management

38

What are the multiple remedies used to treat chronic bone pain in PCM?

narcotic and nonnarcotic pain relievers

localized application of radiation to bone lesions

39

Which gender does PCM occur in most?

men > women