Devita, Hellman, and Rosenberg's Cancer

LWBK1006-34 LWW-Govindan-Review November 24, 2011 11:25

466 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 34.7. A 48-year-old male presents with anemia, hypercalcemia, and multiple

lytic lesions. His bone marrow examination shows 60% plasma cells

with high-risk chromosomal changes including loss of 13q on metaphase

cytogenetics and FISH showing t(4,14). He is started on bortezomib and

dexamethasone therapy. He enquires about the possibility of having stem

cell transplantation. Which of the following is true in this population?

A. Allogenic transplantation should be considered standard of care for

patients with high-risk chromosomal features.

B. Tandem autologous transplantation followed by reduced intensity

allogeneic transplantation results in lower response rates in patients

with high-risk cytogenetics.

C. Autologous transplantation results in lower response rates in patients

with high-risk cytogenetics than patients with normal cytogenetics.

D. These patients may benefit from maintenance therapy after autolo-

gous transplantation.

Question 34.8. A 60-year-old female presents with Hb of 9 g/dL and a creatinine of

1.5 mg/dL. SPEP shows a monoclonal spike of 3.7 g/dL with an IgG

kappa monoclonal protein on immunofixation. Bone marrow examina-

tion shows 27% plasma cells. A skeletal survey shows no lytic lesions.

All the following investigations have been shown to provide additional

information that could be potentially clinically useful except:

A. MRI spine/pelvis

B. Whole body PET scan

C. Gene expression profiling

D. Serum free light chain (SFLC) assay

Question 34.9. A 58-year-old male with anemia is diagnosed with light chain disease. His

SFLC assay shows a kappa light chain level of 100 mg/dL and lambda light

chain level of 2.0 mg/dL with a kappa/lambda ratio of 50. The patient

starts treatment with lenalidomide and dexamethasone. The SFLC assay

can be used to monitor response to treatment using:

A. Decrease in the level of involved light chain

B. Decrease in the level of the difference between involved and unin-

volved light chain

C. Decrease in kappa/lambda ratio

D. The SFLC assay cannot be used to assess response