Introduction To Lymphomas And Myelomas Flashcards
What is lymphoma?
Cancer of the lymphocytes
What does lymphoma affect?
Mature blood cells
What are lymphomas due to?
Specific genetic mutations and chromosomal translocations
What are primary lymph organs?
Sites where stem cells can divide and become immunocompetent
What are secondary lymph organs?
Sites where most of the immune responses occur
What is an adenopathy?
When lymph nodes increase in size
What are the types of lymphoma?
Non-hodgkins
Hodgkins
What are non-hodgkins lymphomas characterised by?
Mature B-cell, T-cell and NK neoplasms
What is a neoplasm?
Abnormal tissue growth
What are the warning signs of lymphoma?
Fever Swelling of the face and neck Lump in neck, armpits or groin Excessive sweating at night Unexpected weight loss Breathlessness Itchiness Feeling of weakness Loss of appetite
How can you diagnose lymphoma?
Lymph node biopsy to check for lymphoma
Then flow cytometry, FISH or NGS to check the type
What are the stages of lymphoma called?
I
II
III
IV
What does stage I lymphoma look like?
Localised disease
Single lymph node region or organ
What does stage II lymphoma look like?
Two or more lymph node regions on the same side of the diaphragm
What does stage III lymphoma look like?
Two or more lymph node regions above and below the diaphragm
What does stage IV lymphoma look like?
Widespread disease
Multiple organs with or without lymph node involvement
What is the etiology of lymphoma?
Malfunctioning of the bodies immune system
Triggers are unknown but generally when a B cell develops a mutation in its DNA
What is hodgkin lymphoma caused by?
50% epstein barr virus
Family history
HIV/AIDS
How do you diagnose hodgkin lymphoma?
By finding a hodgkin cell in a lymph node biopsy
What does a hodgkin cell look like?
Bilobed nucleus
So big you can see by a light microscope
How do you treat hodgkin lymphoma?
Chemotherapy with/without radio
Stem cell transplant
What is the prognosis for hodgkin lymphoma?
5 year survival of 50-90%
What do non-hodgkin lymphomas present with?
Enlarged lymph nodes
What are non-hogkin lymphomas caused by?
Chromosome translocations
What is the normal role of the tissue specific enhancer on the immunoglobulin gene?
Activate the promoter of the rearranged V segment
What are the risk factors for non-hodgkins lymphoma?
Viral infections and human T cell leukaemia virus in adult T cell lymphoma
What happens to the epstein barr virus in highly immunosuppressed individuals?
Endogenous latent EBV transform B cells as no cytotoxic T cells
What are the classifications of non-hodgkins lymphoma?
Low and high grade
What are the features of low grade non-hodgkin lymphoma?
Normal tissue architecture partially preserved
Slow division
May be present for many months before diagnosis
What are the features of high grade lymphoma?
Loss of noraml tissue architecture
Divide rapidly
Present for a matter of weeks before diagnosis
Life threatening
How can you diagnose non-hodgkin lymphoma?
Immunophenotyping
Cylogenics-FISH
Light chain restriction
PCR
How can you treat non-hodgkins lymphoma?
Chemo
Radio
Stem cell transplant
Monoclonal antibody therapy
How does the monoclonal antibody therapy work?
Binds NK cells to B cells and enhances cell death
What is the prognosis for non-hodgkin lymphoma?
Overall 5 year survival rate = 70%
What is a multiple myeloma?
Tumour of the bone marrow that involves plasma cells
What does multiple myeloma present as?
Bone pain
bleeding
Frequent infections
Anaemia
When does multiple myeloma present?
Much later
What are the risk factors for multiple myeloma?
Obesity
Radiation exposure
Family history
Certain chemicals
What are the three aspects associated with multiple myeloma?
Suppression of normal bone marrow, blood cell and immune cell function
Bone resorption and release of calcium
Pathological effects of the paraprotein
What is a paraprotein?
Single monoclonal immunoglobulin in the serum
What does high levels of paraprotein mean?
Malignancy
What does supression of noraml bone marrow, blood cell and immune function cause?
Anaemia
Bleeding
Recurrent infections
Why do multiple myelomas cause bone resorption and release of calcium?
Myeloma cells produce cytokines
- > bone marrow stromal cells releasing RANKL
- > osteoclast activation
What symptoms are caused by calcium release from the bone?
Mental disturbance
What are the effects of high paraprotein?
Precipitates in kidney tubules causing renal failure
Deposited as amyloid in tissues
Hyperviscosity syndrome (rare)
What is hyperviscosity syndrome?
Increased viscosity of blood leading to stroke and heart failure
How can you diagnose multiple myeloma?
Serum electrophoresis for paraprotein Urine electrophoresis Bone marrow biopsy for increased levels of plasma cells Erythrocyte sedimentation rate Flow cytometry and cytogenesis Radiological investigation
Why is the erythrocyte sedimentation rate high in multiple myeloma?
Stalking of the RBC
How do you treat multiple myeloma?
Radio/chemo combination
Targeted therapies
Immunotherapy
Haematopoetic stem cell transplantation in young patients
What is the prognosis for multiple myeloma?
35% survival for 5 yrs
