Lymphoma + Myeloma

Question 1

Define lymphoma

Answer 1

Begins with a malignant change in a lymphocyte (B or T cell), lymph node cell or lymphatic tissue of the marrow

Predominantly nodal or organ based - requires node excision for Dx

Question 2

Outline Non-Hodkins lymphoma

Answer 2

Majority of lymphoma cases

• 14 types of B-cell
• Other types are T-cell and NK cell

Spreads through the lymphatic system in a less orderly way, caught at a later stage

S+S = painless LN swelling, fatigue, weight loss, fever, night sweats, asymptomatic (low grade)

Question 3

Outline Hodkins lymphoma

Answer 3

12% of Lymphoma

One of the most curable 80%

Characterised by

• Presence of Reed-Sternberg cell
• Distinctive B-lymphocytes
• Ann Arbor staging

S+S = LN enlargement, B symptoms, pruritus, alcohol-induced LN pain, cough, SOB

Question 4

How is lymphoma managed?

Answer 4

Low-grade = watchful waiting, DXT, chemo, rituximab (follicular lymphoma)

High grade = chemo, stem cell transplant

Hodgkins = DXT (when localised), chemo (when systemic)

Prophylaxis = aciclovir (herpes), co-trimoxazole (PCP), allopurinol (tumour lysis syndrome)

Question 5

Outline Ann Arbor staging

Answer 5

1 = 1 LN

2 = 2/> LN on same side of diaphragm

3 = LN on both sides

4 = 1/> extralymphatic organs involved

A = asymptomatic 
B = b symptoms (>38.6, drenching night sweats, weight loss >10%/6m)

Question 6

What is myeloma?

Answer 6

Cancer of the plasma cells - paraproteins produced (structurally defunct Abs, recurrent infections)

Question 7

What are the signs and symptoms of myeloma?

Answer 7

Elderly

Bone pain (plasma cells cause mass in BM + pathological fractures, lytic lesions) (lower limbs - young female)

Bleeding

Frequent infections (neutropenia, thrombocytopenia)

HyperCa (bones, stones, groans, psychic moans)

Anaemia

Question 8

Outline the complications of myeloma?

Answer 8

• Renal impairment – often a consequence of hyperCa – requires urgent attention and pts may need to be referred for long-term peritoneal dialysis or haemodialysis
• HyperCa should be treated by rehydration and use of bisphosphonates, such as pamidronate
• Spinal cord compression due to myeloma is treated with dexamethasone, followed by RT to the lesion delineated by a MRI
• Hyperviscosity due to high circulating levels of paraprotein may be corrected by plasmapheresis

Question 9

How is myeloma investigated?

Answer 9

ESR (high), serum protein electrophoresis, x-ray (lytic lesions), BM biopsy (>10% plasma cells), Ca, Cr, anaemia (normochromic, normocytic)

Para-proteins = kappa/lambda light chains (structurally defunct)

Bence jones proteins - filtered by kidney

Question 10

How is myeloma treated?

Answer 10

Chemo - IMIDs, dexamethasone, cyclophosphamide proteasome inhib

Autologous stem cell transplant = can give a big dose of chemo, then give back stem cells for BM to recover

SYMPTOMATIC:
- Bone pain = analgesia, bisphosphonates (zoledronic acid), DXT

• Anaemia = transfusion, EPO
• Renal = increase fluid intake, dialysis in AKI
• Infection = broad spec Abx, Ig infusions if recurrent
• Hyperviscosity = plasmapheresis (remove light chains)