41 - Lymphoma and Myeloma

Question 1

may be worth looking at B cell development pathway

Answer 1

first slides on lecture

Question 2

Ig - features

Answer 2

Glyoprotein molecules produced by plasma cells

Two light and two heavy held by covalent disulphide bonds

One variable and one constant region

Question 3

How are Ig classified?

Answer 3

Based on aa sequence in constant region of heavy chains: determines IgG,M,A,D,E

Light chain determines kappa or lambda

Question 4

Protein electrophoreis is…

Answer 4

Lab technique whereby serum is placed in gel and exposed to electric current

Question 5

5 major fractions in protein electrophoresis

Answer 5

Serum albumin (biggest spike)
Alpha-1 globulins
Alpha-2 globulins
Beta globulins
Gamma globulins

From left to right

Question 6

What happens to the protein electrophoresis in multiple myeloma?

Answer 6

“M-spike” in gamma section

Question 7

Immunofixation takes place after protein electrophoresis why?

Answer 7

Anti-immunoglobulin antisera is added to each migration lane and if the immunoglobulin is present a complex precipitates

Question 8

Dyscrasia meaning

Answer 8

an abnormal or disordered state of the body or of a bodily part.

Usually - blood components

Question 9

What diagnostic criteria is used for myeloma?

Answer 9

IMWG

Question 10

Primary lymphoid organs

Answer 10

(red) bone marrow and thymus gland

Question 11

Secondary lymphoid organs

Answer 11

Lymph nodes and spleen

Question 12

How do most people with myeloma present?

Answer 12

With kidney insufficiency

Question 13

External factors affecting kidney sufficiency

Answer 13

Renal vein thrombus
Bisphosphonates
Hypercalcaemia
ACEi
Dehydration
NSAIDs
CT contrast
Hyperviscosity

Question 14

AKI with myeloma is what

Answer 14

A MEDICAL EMERGENCY

Question 15

AKI w/ myeloma treatment

Answer 15

TIME = NEPHRONS
Blood film + electrophoresis + immunofixation + bone marrow biopsy w/ flow cytometry

Treatment with steroids

Question 16

IMWG diagnostic criteria for myeloma

Answer 16

Serum M-protein

Question 17

Amyloidosis found by

Answer 17

Renal stain on kidney biopsies where amyloid shows up apple green

Deposit and aggregate in kidneys

Question 18

What is amyloidosis? + pathogenesis

Answer 18

Amyloid light chain fragments misfold and self-aggregate forming beta-pleated fibrils causing damage into multiple organs

Question 19

Follicular lymphoma - definition

Answer 19

Neoplastic disorder of lymphoid tissue

Type of non-Hodgkin lymphoma characterised by slowly enlarging lymph nodes

Question 20

Follicular lymphoma - clinical presentation

Answer 20

Lumps in neck

Question 21

Follicular lymphoma - % of all non-Hodgkin lymphoma diagnoses

Answer 21

15%

Question 22

Follicular lymphoma - epidemiology

Answer 22

M=F

Incidence rises with age

Question 23

Hodgkin Lymphoma - defined by

Answer 23

Presence of Hodgkin Reen-Sternberg cells (HRS) in the presence of cellular infiltrate of non-malignant inflammatory cells

Question 24

Hodgkin Lymphoma - epidemiology

Answer 24

2.7 per 100,000

Peak in 10s and 20s and then again in 70s

Question 25

Hodgkin Lymphoma - prognosis

Answer 25

Related to severity of treatment but 86% 5 year survival rate

Question 26

Hodgkin Lymphoma - treatment

Answer 26

Chemo and radiotherapy

Question 27

Hodgkin Lymphoma - problems with treatment

Answer 27

Very damaging
Increased mortality >20years down the line
Pulm toxicity
CVD
2° malignancies