Myeloma, Lymphoma & acute Leukaemia Flashcards
What are immunoglobulins?
-glycoproteins producedby plasma cells in response to an immunogen
What is myeloma?
-Incurable malignant disorder of clonal plasma cells
What is the diagnostic criteria for myeloma?
-Clonal plasma cells >10%
-Extramedullary plasmacytoma
AND
CRAB features, MDEs
How is myeloma linked to the kidneys?
- Renal insufficiency or impairment despite therapy
- Acute kidney injury & myeloma = medical emergency
Describe amyloidosis
- Amyloid light chain amyloidosis
- light chain fragments misfold and self-aggregate to form beta pleated fibrils
What is follicular lymphoma?
- Neoplastic disorder of lymphoid tissue
- Type of non-hodgkin lymphoma characterised by slow enlarging lymph nodes
- Male & females affected equally
- Incidence rises with age
In terms of genetics how does follicular lymphoma occur?
- Acquired chromosomal translocation
- Brings bcl2 proto-oncogene under influence of the immunoglobulin heavy chain gene
- Leads to inhibiting apoptosis
How does acute leukaemia occur?
- Somatic mutation in a single cell within a population of early progenitor cells
- De novo mutation
- Terminal event of pre-existing blood disorder
- Accum of early myeloid or lymphoid precursors in bone marrow, blood or tissue
What are the clinical features of AL?
- Features of bone marrow failure: anaemia, infections, easy bruising & haemorrhage
- Organ infiltration: spleen, liver, meninges, skin, testes
How is AL diagnosesd?
- Morphology (FAB, WHO)
- Cytochemistry
- Immunological markers (monoclonal antibodies & FACS)
- Cytogenetics/FISH (indicate subtype)
- Molecular techniques(PCR)
Name the chromosomal abnormalities in ALL and their prognosis
- High hyperdiploidy=favourable
- Hyperdiploidy & pseudodiploidy=intermediate
- Hypodiploidy=poor
- Structural abnormalities=intermediate-very poor
What molecular abnormalities can be seen in AL?
-Chromosomal translocation cause molecular changes important in aetiology. Philadelphia chromosome= t(9;22)
Give the molecular pathology of AML
- Abnormal cell proliferation= Ras & FLT3 mutations (bad)
- Block in differentiation= MLL translocation
- Tumour suppression= NPM1 (good)
What factors in ALL lead to a poor prognosis?
- Increasing age
- High WCC
- Male
- Poor response to treatment
- T-ALL & null-ALL
- Certain cytogenetic abnormalities
What is the treatment for ALL &/ AML?
AML= obtain remission, then combination chemo, consider bone marrow transplant ALL= All patients receive chemo, prophylaxis of meningeal leukaemia w/intrathecal methotrexate & cranial irradiation, bone marrow transplant in bad patients
