Lymphoma and Myeloma Flashcards
What are the CRAB features?
Hypercalcaemia
Renal impairment
Anaemia
Lytic bone lesions
In which type of myeloma are the bone lesions sclerotic?
Poems
What is immunoparesis?
Relative deficiency in endogenous, protective Ig, that is replaced by pathological paraprotein
What is lymphoma?
Malignant tumours of lymphoid tissue (not arising primarily from bone marrow)
What are Reid-Sternberg cells?
Binucleated giant cells (owl eyed) typically seen in Hodgkin lymphoma
How is treatment divided in Hodgkin lymphoma?
<2A - Local radiotherapy only
>2B - Local radiotherapy and chemotherapy
Define CHOPR, define how it’s cycled
Cyclophosphamide - haemorrhage cytitis, and renal impairment
Hydroxydaunorubicin (adriamycin) - cardiac toxicity
Oncovin (vincintine) - peripheral neuropathy
Prednisolone
Rituximab
CHO on day one and P on day 1 to 5 is one cycle, do a cycle every 3 weeks or so depending on bone marrow response
Which lymphoma would you expect in young patients?
Hodgkin lymphoma
Burkitt
Lymphoblastic
Anaplastic large cell
Where does Hodgkin lymphoma typically present?
Neck and mediastinal nodes
Which type of lymphoma is common in the groin?
T-cell lymphoma
A polyclonal process is typical of benign or malignant lymphoma?
Benign
A monoclonal process is typical of benign or malignant lymphoma?
Malignant
Describe the light chain phenotype in malignant myeloma?
It is restricted to cappa or lambda
Which lymphoma has a classic starry sky appearance on histopath?
Burkitt lymphoma
How do nodes in Hodgkin lymphoma feel on palpation?
Rock hard
What are the major side effects of each of the CHOPR drugs?
Cyclophosphamide - haemorrhage cytitis, and renal impairment
Hydroxydaunorubicin (adriamycin) - cardiac toxicity
Oncovin (vincintine) - peripheral neuropathy
Prednisolone
Rituximab - Lymphopenia
What characteristic urine feature do you get in multiple myeloma? What is it?
Bence-Jones protein
Light chains
What is MGUS? How is it significant?
Monoclonal gammopathy of undetermined significance - paraprotein is present in the absent of myeloma
People with it are at higher risk of developing myeloma
Are Ix are specific for diagnosing MM?
Serum and urine electrophoresis
B-2 Microglobulin
Bone marrow examination
Xray skull, spine and long bones
How is MM treated?
Melphalan
Cyclophosphamide
Thalidomide
Bone marrow transplant
Plasmapheresis to reduce paraprotein if causing symptoms
Bisphosphonates for bone
What des MM look like on bone marrow biopsy?
>5% plasma cell
With irregular morphology - increase blue in cytoplasm
When does MGUS become myeloma?
When there are
- CRAB symptoms
- Bone marrow >10% plasma cells
When should you suspect MM?
Pathological fracture
Unexplained renal failure
Unexplained hypercalcaemia
Unexplained anaemia with rouleax (staking of RBCs)
High total protein despite low/normal albumin
What do you see on low power views of Hodgkin lymphoma LNs?
Nodularity and sclerosis
