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BCOP > Multiple Myeloma > Flashcards

Multiple Myeloma Flashcards

1
Q

disease progression

A

MGUS->smouldering myeloma->intramedullary myeloma->extramedullary myeloma->myeloma cell line

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2
Q

signs and symptoms -2

A
  • CRAB - calcium >11.5, renal dysfunction (SCr >2), anemia (hgb), bone
  • presents as HA, blurred vision, epistaxis, oral bleeding, AMS, confusion->start plasmapheresis to tx
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3
Q

diagnosis - MGUS -2

A

m-protein <10%

no related orgain impairment

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4
Q

diagnosis - asymptomatic myeloma -3

A

m-protein >30g/L
bone marrow plasma cells >10%
no related orgain impairment

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5
Q

diagnosis - symptomatic myeloma -2

A

m-protein 10%

orgain impairment = CRAB

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6
Q

staging - ISS -3

A

stage I: B2M 3.5 =OS 62 mo
stage II: neither I or III =OS 44 mo
stage II: B2M >5.5 =OS 29 mo

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7
Q

staging - mSMART - high risk -3

A

FISH del 17p, t14;16, t14;20

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8
Q

staging - mSMART - intermediate risk -3

A

FISH t4;14, cytogenetic del 13q OR hypoploidy

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9
Q

staging - mSMART - standard risk -3

A

hyperploidy, FISH t11;14 OR t6;14

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10
Q

response criteria - CR -3

A
  • serum and urine immunofixation (-)
  • no soft tissu plasmacytomas
  • <5% plasma cells in BMBx
  • *this will not be on test
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11
Q

how do you decide if autoSCT eligible? -3

A

age, PS, co-morbidity

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12
Q

if potential autoSCT candidate should you use melphalan? -1

A

Don’t use alkylator (melphalan) based chemo in induction. melphalan at high doses is toxic to stem cells

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13
Q

induction tx - non-HSCT - preferred regimens -5

A 
bortezomib-dex
lenalidomide-low dose dex
melphalan-pred-bortezomid
melphalan-pred-thalidomide
melphalan-pred-lenalidomide
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14
Q

induction tx - non-HSCT -MP vs MPT

A

OS 64 vs 84% @3yr
CR 7 vs 28%
PFS 27 vs 54% @2yr

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15
Q

induction tx - non-HSCT -MP vs b-MP

A

OS not reported

CR 4 vs 30%

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16
Q

induction tx - non-HSCT -are 4 drugs better than 3 drugs? VMP vs VMPT

A

NO.
OS 89 vs 87% @3yr
CR 24 vs 38%

17
Q

induction tx - HSCT candidates- concepts of dex, L, and T combo’s -

A
  • low dose dex-L >high dose dex-L: CR+VGPR 50 vs 40%
  • dex-T > dex alone: CR+VGPR 44 vs 16%
  • VAD (vinc-doxo-dex) used previously->CR 28%, replaced by DvD (peg doxo-vinc-dex)
18
Q

lenalidomide and autoSCT -2

A

lenalidomide->cummalitive tox to bone marrow, collect cells prior to 4-6 cycles of tx

19
Q

induction tx - HSCT candidates- preferred regimens -9

A 
bortezomib-dex
bortezomib-dex-cyclophos
bortezomib-doxo-dex
bortezomib-lenalid-dex
bortezomib-thalid-dex
lenalid-dex
OPTIONAL
DvD (liposomal doxo-vinc-dex)
thalid-dex
dex
20
Q

What is the effect of induction regmen on OS post HSCT?

A

higher CR in induction = higher CR post HSCT; choose induction regimen that obtains highest CR in induction as has implications post tx

21
Q

DVT risk - T, L, dex -

A

T, dex D1-4,9-12,17-20: 17%
L, dex D1-4,9-12,17-20: 26%
L, weekly dex: 12%

22
Q

thromboembolism px -T, L, dex -3

A
  • first 6 mo: ASA 6.4%, warf 8.2%, lmwh 5%
  • entire f/u: ASA 8.6%, warf 10%, lmwh 7.8%
  • NO CLEAR BEST CHOICE
23
Q

nuances of HCT -4

A

-2x10^6 CD34+/kg (watch melphalan, lenalidomide)
-inc harvest with cyclophos+gcsf
chemo-mobilization with cyclophos MAY overcome lenalid TOX (use if >4cycles L)
-if >65y->red cyclophos OR plerixafor

24
Q

HCT priniciples ???

A

benefit to 2nd autoSCT if less than VGPR to 1st
lack of convincing data to support using autoSCT -> reduced intensity chemo vs tandem autoSCT
do NOT use alloSCT as 1st line

25
Q

Risks for POOR mobilization -6

A

age, melphalan, thalidomide >4cycles, extensive prior tx, prolonged dz duration, extensive XRT to BM

26
Q

maintaining remission post HSCT remains a primary objective - T, L maintenance

A

both T and L have a role in improving OS post HSCT

27
Q

second primary malignancies -lenalidomide maintenance

A

4-7% vs 1-2.6% with placebo

28
Q

salvage regimens - if remission greater than 6 months, repeat original, otherwise -13

A

bendamustine, bortezomib (B), BD, B-lena-D, B-lipo dox, CyBorD, Cy-lenaD, D-cy-etop-cis, D-thal-cis-doxo-cy-etop (DT-PACE) +/- B =VDT-PACE, high dose Cy, lena-D, thal-D

29
Q

skeletal related events -5

A

hypercalcemia of malig, path fx, bone pain, spinal cord compression
Tx: xrt to bone, bone surgery

30
Q

bisphosphonates in MM (ASCO)

A
  • lytic bone dz: pam 90 q3-4 wks, ZA 4 q3-4wks FOR 2 YEARS, then resume with onset of new SRE
  • indolent: not suggested
  • osteopenia WITHOUT lytic dz: may consider
  • pain control: adjunctive, multimodal tx
31
Q

bisphosphonate monitoring -5

???

A

albuminuria, azotemia, SCr (prior to each dose, hold tx for deteriation in renal func until return to within 10% of baseline). FOLLOW INFUSION TIME GUIDELINES look up

32
Q

osteonecrosis of the jaw associations -3

A

duration of exposure, dental procedure, concurrent thalidomide

33
Q

renal impairment -2

A 
#bor-D to rapidly reverse disease-induced nephropathy
#lenalid dose adjusted for GFR
#melphalan 140mg/m2 for CrCl <60

BCOP (32 decks)

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