W4 lect7: myeloma and CLL

Question 1

WHAT IS lymphoma?

Answer 1

1. malignancy involving lymphoid cells
   - B-cell or T-cell, B-cell by far most common
2. Involve lymph nodes and/or secondary lymphoid tissues (SLO), (spleen, thymus, Peyer’s patch, mucosal tissues)
3. Spread to:
   * Bone marrow
   * Peripheral blood spill over
   * Other organs

Question 2

what is leukamia?

Answer 2

1. malignancies of the bone marrow +/- peripheral blood involvement
2. > 20% malignant white cells in peripheral blood or
   bone marrow
3. Clinical features due to:
   * Bone marrow infiltration (replacement of normal
   haemopoiesis)
   * High white cell counts (abnormal white cells)

Question 3

why does classification matter?
*Leukaemia & lymphoma

Answer 3

1. Disease will be detected by clinician in blood or LAD (most of the time)
2. Requires appropriate supportive management, referral, and work-up

Question 4

why does classification matter?
* Lymphoid vs myeloid

Answer 4

• Flow cytometry on blood?
• FISH studies?
• BMAT?
• Supportive investigations?

Question 5

why does classification matter?
chronic vs acute

Answer 5

• Aggressive vs indolent
• Urgency of investigation and referral
• Management until patient is transferred

Question 6

what is the chronic lymphocytic leukaemia/ lymphoma?

Answer 6

• Clonal (malignant) proliferation and accumulation of mature B-cells
• Involving blood/BMA/lymph nodes

Question 7

what is the epi. of CLL?

Answer 7

• Most common adult leukaemia.
• ~1-3 / 100 000 per annum (USA).
• Disease of the elderly, most frequent >70 years.
• Increased in males.
• Genetic basis - seen more commonly in America and
  Europe&raquo_space; Asia and Africa. Seen in all population groups
  in South Africa.
• Familial cases well described.

Question 8

what is the M:F ratio?

Answer 8

1.9: 1

Question 9

what is the clinical presentation of CLL?

Answer 9

1. Asymptomatic with incidental raised WCC – due to lymphocytosis
   * Up to 50% patients
   * WCC > 10 x 109/L
   * Abs lymphocyte > 4 x 109/L
2. Other features of leukaemia/lymphoma:
   * +/- BMF symptoms – anaemia/neutropaenia/thrombocytopaenia
   * +/- LAD or HSM – Mass (abdominal or other)
   * +/- B-symptoms (more aggressive disease or due to splenomegaly

Question 10

HOW do we investigate or diagnose?

Answer 10

• cytometry

Question 11

what myeloma/ plasma cell myeloma?

Answer 11

• Plasma cell malignancy
• Monoclonal plasma cells
• Proliferate in bone marrow

Question 12

where do we look for plasma cells?

Answer 12

bone marrow aspirate and trephine

Question 13

what are the supportive investigations?

Answer 13

• To look for end organ damage
• Renal function
• FBC
• CMP
• Skeletal survey

Question 14

where do we look for paraprotein?

Answer 14

• urine
• blood

Question 15

conquences of paraprotein collection?

Answer 15

1. Overabundance monoclonal paraprotein (M protein)
   * Renal impairment
2. Destruction of bone
   * Hypercalcaemia
3. Displacement of other hematopoietic cell lines
   * Anaemia
   * Neutropaenia
   * Thrombocytopaenia

Question 16

diagnoses of mml

Answer 16

• blood screening
• bone pain is the most prevalent presenting symptom
• CRAB criteria: hypercalcaemia, renal imparment, anaemia, bone lesions

Question 17

diagnosis/ work- up?

Answer 17

1. Serum protein electrophoresis
2. Urine protein electrophoresis
3. Baseline investigation for end organ damage
   * Renal function
   * FBC
   * CMP
   * Skeletal survey
4. BMAT – for diagnosi

Question 18

Second commonest haematologic cancer in adults
after non-Hodgkin lymphoma

Answer 18

multiple myeloma

Question 19

common systoms assoc. with multiple myeloma

Answer 19

• bone pain
• weakness, malaise
• anemia, bleeding
• hypercalcemia
• spinal cord compression
• pathologic fractures
• infections
• neuropathies

Question 20

treatment of mml

Answer 20

• drugs
• bone marrow transplantation