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26 Cards in this Set
- Front
- Back
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Multiple myeloma is characterized by proliferation and accumulation of what?
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clonal plasma cells
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Multiple myeloma is diagnostic when plasma cells reach > what percent?
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40%
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The proposed model of multiple myeloma is normal plasma cell --> _____ --> multiple myeloma
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MGUS
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What sign/symptom is seen in 80% of patients with multiple myeloma?
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bone pain
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What is the acronym for the most common signs and symptoms of multiple myelomas? What does it stand for?
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CRAB
Calcium increase Renal insufficiency Anemia Bone pain |
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Stage 1 multiple myeloma has what values of serum beta2 microglobulin and albumin?
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Serum beta2 microglobulin < 3.5
albumin > 3.5 |
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Stage 2 multiple myeloma has what values of serum beta2 microglobulin and albumin?
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Serum beta2 microglobulin 3.5-5.4
albumin < 3.5 |
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Stage 3 multiple myeloma has what values of serum beta2 microglobulin and albumin?
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Serum beta2 microglobulin > 5.4
no albumin measurements |
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What agent is avoided in multiple myeloma if there is potential for a transplant in the future?
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melphalan
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What are the 3 older regimens for myeloma?
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MP (melphalan, prednisone)
Dexamethasone VAD (vincristine, doxorubicin, dexamethasone) |
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What are the 3 newer regimens for myeloma?
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Thalidomide/dexamethasone
DVD (pegylated liposomal doxorubicin, vincristine, dexamethasone) Bortezomib +/- dexamethasone |
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What are the 4 novel regimens for myeloma?
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Bortezemib + doxil
VMP (bortezomib, melphalan, prednisone) Rev/Dex (lenalidomide, dexamethasone) RVD (lenalidomide, bortezomib, dexamethasone) |
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What is the dosing for bortezomib for multiple myeloma?
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1.3 mg/m2 IV push on days 1, 4, 8, and 11 (followed by 10 day rest period)
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Bortezomib is metabolized by what?
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3A4, 2C19, 1A2
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Why does bortezomib require a 72 hour rest period in between doses?
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allows for restoration of proteasome function
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What are the 3 major toxicities of liposomal doxorubicin (Doxil)?
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hand-foot syndrome
mucositis neutropenia |
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Thalidomide is combined with what other 3 agents for myelomas?
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dexamethasone
bortezomib MP |
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What grade 3-4 adverse events are associated with thalidomide?
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DVT
peripheral neuropathy weakness |
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What is the dose for lenalidomide for multiple myeloma?
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25mg Qdays 1-21 every 28 days
(in combination with dexamethasone) |
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What drug is primarily combined with lenalidomide for multiple myeloma?
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dexamethasone
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What grade 3-4 toxicities are associated with lenalidomide?
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DVTs, PEs
Neutropenia Thrombocytopenia |
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Prophylaxis with one of which 3 drugs is recommended for thromboembolic events caused by thalidomide or lenalidomide in multiple myeloma?
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aspirin
LMWH heparin |
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What is the treatment for grade 2 peripheral neuropathy from thalidomide?
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TCAs
amino acids |
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What is the treatment for grade 2 peripheral neuropathy from bortezomib?
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dose reduction
gabapentin/pregabalin amino acids 5% lidocaine patch |
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What is the general treatment for grade 3 peripheral neuropathy from thalidomide or bortezomib?
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already dose-reduced, now we're going to change the schedule
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True or False - All patients with myeloma get treated with bisphosphonates, even if they do not have lytic bone disease
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True (NCCN 2011)
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