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omgmbd > L26: Intro To Lymphomas & Myeloma > Flashcards

L26: Intro To Lymphomas & Myeloma Flashcards

1
Q

Which cells are involved in lymphomas?

A

→mostly B lymphocytes
→ T lymphocytes
→natural killers

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2
Q

What are the main functions of the lymph nodes?

A

→blood filtration/purification

→removal of excess fluids from tissues

→absorption and transport of lipids

→Immune system activation

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3
Q

What are primary lymph organs?

A

→sites where stem cells can divide and become immunocompetent

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4
Q

→What are secondary lymph organs?

A

→sites where most of the immune responses occur

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5
Q

When lymphomas spread to the bone marrow, how are they detected?

A

→detectable in blood

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6
Q

What are the traditional classifications of lymphomas?

A

→Non-Hodgkin’s

→Hodgkins

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7
Q

What are the two types of Non-Hodgkin’s lymphomas?

A

→diffuse

→follicular

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8
Q

What is the age of onset of HK and NHK lymphomas?

A 
→HK= 75-79
→NHK= 80-84
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9
Q

What are the warning signs of lymphomas?

A 
→swelling of face and neck
→excessive sweating at night
→unexpected weight loss
→breathlessness
itchiness
→loss of appetite
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10
Q

How are lymphomas diagnosed?

A 
→lymph node biopsy
→immunophenotyping
→NGS
→FISH
→flow cytometry
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11
Q

What are the PET stages of lymphomas?

A

→Stage 1= localized disease, single lymph node
→Stage 2= two or more lymph nodes on the same of the diaphragm
→Stage 3= two or more nodes above and below diaphragm
→Stage 4= widespread disease, multiple organs

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12
Q

How do most lymphomas occur?

A

→when a B cell develops/acquires a mutation in its DNA

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13
Q

What is Hodgkin lymphoma?

A

→Clonal B-cell malignancy

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14
Q

What is the presentation of HK lymphomas?

A

→Presentation- non-painful enlarged lymph node(s)

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15
Q

What are the risk factors of HK lymphomas?

A

→50% cases due to Epstein-Barr virus
→Family history
→HIV/AIDS

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16
Q

How is HK lymphomas diagnosed?

A

→Excisional lymph node biopsy
→Reed-Sternberg cell present
→observed by light microscope

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17
Q

What are the features of Reed-Sternberg cells?

A

→multinucleated

→condensed cytoplasm

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18
Q

What is the treatment for HK lymphomas?

A

→Chemotherapy +/- radiotherapy

→Stem cell transplant

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19
Q

What is the prognosis for HK lymphomas?

A

→5 year survival ~50-90% depending on age, stage and histology

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20
Q

What are two high grade NHK lymphomas?

A

→diffuse large B cell

→Burkitt

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21
Q

What is the main presentation of HK lymphomas?

A

→enlarged lymph node

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22
Q

What is a cause of NHK lymphomas?

A

→Chromosome translocations detected using FISH

23
Q

What are the risk factors for NHK?

A

→virus infection

24
Q

What are viral risk factors for NHK?

A

→EBV (HHV4) in Burkitt’s lymphoma

→ Human T-cell leukaemia virus in adult T-cell lymphoma

→H.Pylori in gastric lymphoma

25
Q

What is the chromosome translocations in NHK?

A

→Ig heavy chain or light chain loci (chr14)

26
Q

How does Ig-BCL-2 fusion created?

A

→Ig gene has a powerful tissue specific enhancer in B-cells

→translocation brings BCL-2 which is an apoptosis inhibitor under the influence of Ig enhancer

27
Q

Which chromosomes are involved in IG-BCL-2 fusion of follicular lymphoma?

A

→14 and 18

28
Q

Which chromosomes are involved in Ig-C-MYC fusion of Burkitt’s lymphoma?

A

→t(8;14)(q24;q32)

29
Q

What does the Epstein Barr virus due to B-cells in those immunosuppressed?

A

→directly transforms B-lymphocytes in culture.

→Due to viral oncogene LMP-1

→high grade lymphoma.

30
Q

What are the features of low grade NHK?

A

→Normal tissue architecture partially preserved -normal cell of origin recognisable

→Divide slowly

→May be present for many months before diagnosis

→Behave in an indolent fashion

31
Q

What are the features of high grade NHK?

A

→Loss of normal tissue architecture -normal cell of origin hard to determine

→Divide rapidly

→Present for a matter of weeks before diagnosis

→May be life-threatening

32
Q

What are the diagnostic techniques for NHK?

A

→Immunophenotyping
→Cytogenetics –FISH
→Light chain restriction
→PCR-For clonal Ig gene rearrangement

33
Q

What is NHK diagnosis similar to?

A

→chronic myeloid leukaemia

34
Q

What are the treatments for NHK?

A

→Chemotherapy
Radiotherapy
Stem cell transplant
Monoclonal Ab therapy

35
Q

Example of MAb for NHK

A

→Rituximab (anti-CD20)

36
Q

What is normally found on surface of lymphoma cells?

A

→CD20

→Antibodies mark the CD20 and then is killed by releasing cytotoxin

37
Q

What is the survival rate in nHK?

A

→70%

38
Q

What is myeloma?

A

→Tumour of the bone marrow that involves plasma cells

39
Q

What are the initial symptoms of myeloma?

A

→Absence of initial symptoms

40
Q

What are the later symptoms of myeloma?

A

→bone pain,
→bleeding,
→frequent infections,
→anaemia

41
Q

What do abnormal plasma cells produce?

A

→paraprotein

42
Q

What are paraproteins?

A

→monoclonal immunoglobulin or light chain

43
Q

How are Bence-Jones proteins detected?

A

→blood or urine

→homogeneous gel migration

44
Q

Why is there hypercalcaemia observed in myelomas?

A

→Myeloma cells produce cytokines (esp. IL-6)
→ bone marrow stromal cells to release the cytokine RANKL
→ osteoclasts activation
→Calcium released

45
Q

What are the three features of myelomas that give rise to clinical features?

A

→Suppression of normal bone marrow, blood cell and immune cell function

  1. Bone resorption and release of calcium
  2. Pathological effects of the paraprotein –(single monoclonal Ig in the serum- high levels – malignancy)
46
Q

Why is there hyper viscosity syndrome in myeloma?

A

→paraprotein precipitates in kidney
→renal failure
→Deposited as amyloid in many tissues

47
Q

What are the diagnostic techniques of multiple myeloma?

A

→Serum electrophoresis for paraprotein
→Urine electrophoresis
→Bone marrow biopsy for increased levels of plasma cells
→Erythrocyte sedimentation rate (ESR)-

48
Q

Why is ESR performed for myeloma?

A

→high due to stacking of the RBC- forms Rouleaux’s due to increased paraprotein
→Flow cytometry and cytogenetics to detect cause

→Radiological investigation of skeleton for lytic lesions

49
Q

What are the treatments for MM?

A

→Radiotherapy
→chemotherapy combinations →targeted therapies
→immunotherapy (CAR-T),
→allogeneic hematopoietic stem cell transplantation (ASCT) in young patients.

50
Q

What is the survival rate for MM?

A

→35%

51
Q

Which type of cancers are stem cells and bone marrow transplants mainly used for?

A

→AML

52
Q

What are the two types of stem cell transplants?

A

→allogenic

→autologous

53
Q

What is CART cell therapy?

A

→treatment of haematological cancers

→T cells produce chimeric antigen receptors on their surface

omgmbd (29 decks)

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