Introduction to Lymphoma and Myeloma Flashcards
What is lymphoma?
A cancer of the white blood cells
- Affect stature blood cells mostly b but also t lymphocytes
- Heterogeneous group of diseases
What are the main functions of lymph nodes
- blood filtration/purification
- removal of excess fluids from tissues
- absorption and transport of lipids
- Immune system activation
What is meant by primary lymph organs
Sites where stem cells can divide and become immunocompetent
what is meant by secondary lymph organs
Sites where most of the immune responses occur
What is the steps in which a lymphoma is formed
- Affect lymphocytes in different maturation stages
- Uncontrolled division
- Organ size increase: Lymph node (adenopathy) Other lymph organs (splenomegaly)
- Spread to other tissues through lymphatic system
- Might infiltrate in bone marrow (detectable in blood) and/or other organs
How are lymphomas classified
- Hodgkin Lymphoma
- Non-Hodgkin lymphoma
What are the warning signs of lymphoma
- Fever
- Swelling of the face and neck
- Lump in the neck, armpits or groin
- Excessive sweating at night
- Unexpected weight loss
- Loss of appetite
- Breathlessness
- Feeling of weakness
How do we diagnose lymphomas
- Lymph node biopsy
- Histology analysis
- Immunophenotyping
- NGS
- FISH
- Flow Cytometry
How are lymphomas classified and staged
Stage 1: Localised disease, single lymph node
Stage 2: 2 or more lymph nodes on the same side of the diaphragm
Stage 3: 2 or more lymph nodes above and below diaphragm
Stage 4: Widespread disease, multiple organs with or without lymph node involved
What are the causes of lymphomas
Multifactorial disorder:
- Malfunctioning of the body’s immune system
- Exposure to certain infections e.g: HPV
The triggers remain unknown but most lymphomas occur when a B cells develops/acquires DNA mutations
What is Hodgkin lymphoma
- Clonal B-cell malignancy
- Presents as non-painful enlarged lymph nodes
- Risk factors: EBV, Family history and HIV/AIDS
How can we diagnose Hodgkin lymphoma
Excisional lymph node biopsy
- Reed-Sternberg cell is a hall mark of Hodgkin lymphoma
How do we treat Hodgkin lymphomas and what is it prognosis
- Chemotherapy and radiotherapy
- Stem cell transplant
5-year survival 50-90% depending on age and stage of histology.
How do we classify Non-Hodgkin lymphomas
- High grade
- Low grade
- High and low grade
What characteristics are present in high-grade non-Hodgkin lymphomas
- Diffuse large B cell lymphoma
- Burkitt lymphoma
What characteristics are present in low-grade non-Hodgkin lymphomas
- Marginal zone lymphoma
- Follicular lymphoma
- Mantle cell lymphoma
What characteristics are present in high and low grade non-Hodgkin lymphomas
T cell lymphoma (all subtypes)
How do non-Hodgkin lymphomas present in patients
Enlarged lymph node(s). Some forms are slow and others grow faster. General lymphoma symptom
What are the risk factors in non-Hodgkin lymphomas
- Virus infections e.g: EBV
- Human T-cell leukaemia
What are the causes of non-Hodgkin lymphomas
Chromosome translocations
- Many lymphomas carry chromosome translocations involving the Ig heavy chain or light chain loci (chr14).
- Ig genes are highly expressed in B- -cells.
- Each Ig gene has a powerful tissue specific enhancer (high expression levels).
How do chromosome translations cause lymphoma
- Normally the enhancer activates the promoter of the rearranged V segment
- The enhancer promotes gene expression of the BCL-2 gene an apoptosis inhibitor
- Often observed in Burkitt’s lymphoma
How is viral infections such as EBV a risk factor for lymphoma
- It transforms B-lymphocytes in culture. Due to viral oncogene LMP-1
- In highly immunosuppressed patients EBV transforms B-cells and are no longer eliminated by cytotoxic T-cells
- Develop high grade lymphoma
How is non-Hodgkin lymphoma diagnosed
- Immunophenotyping
- Cytogenetics - FISH
- Light chain restriction
- PCR
How is non-hodgkin lymphoma treated
- Chemotherapy
- Radiotherapy
- Stem cell transplant
- Monoclonal Ab therapy -Rituximab (anti-CD20)
What is multiple myeloma
Tumour of the bone marrow that involves plasma cells (antibodies production).
How does multiple myeloma present in patients
- Absence of initial symptoms
- Later: bone pain
- bleeding
- frequent infections
- anaemia.
What are the risk factors of multiple myeloma
- Obesity
- radiation exposure
- family history
- certain chemicals.
What are the 3 clinical features of multiple myeloma
- Suppression of normal bone marrow, blood cell and immune cell function
- Bone resorption and release of calcium (osteoclast activation via cytokines)
- Pathological effects of the paraprotein –(single monoclonal Ig in the serum- high levels – malignancy)
How is multiple myeloma diagnosed
- Serum electrophoresis for paraprotein
- Urine electrophoresis
- Bone marrow biopsy for increased levels of plasma cells
- Erythrocyte sedimentation rate (ESR)-high due to stacking of the RBC
- Flow cytometry and cytogenetics to detect cause
- Radiological investigation of skeleton for lytic lesions
