W4 lect7: myeloma and CLL Flashcards
1
Q
WHAT IS lymphoma?
A
- malignancy involving lymphoid cells
- B-cell or T-cell, B-cell by far most common - Involve lymph nodes and/or secondary lymphoid tissues (SLO), (spleen, thymus, Peyer’s patch, mucosal tissues)
- Spread to:
* Bone marrow
* Peripheral blood spill over
* Other organs
2
Q
what is leukamia?
A
- malignancies of the bone marrow +/- peripheral blood involvement
- > 20% malignant white cells in peripheral blood or
bone marrow - Clinical features due to:
* Bone marrow infiltration (replacement of normal
haemopoiesis)
* High white cell counts (abnormal white cells)
3
Q
why does classification matter?
*Leukaemia & lymphoma
A
- Disease will be detected by clinician in blood or LAD (most of the time)
- Requires appropriate supportive management, referral, and work-up
4
Q
why does classification matter?
* Lymphoid vs myeloid
A
- Flow cytometry on blood?
- FISH studies?
- BMAT?
- Supportive investigations?
5
Q
why does classification matter?
chronic vs acute
A
- Aggressive vs indolent
- Urgency of investigation and referral
- Management until patient is transferred
6
Q
what is the chronic lymphocytic leukaemia/ lymphoma?
A
- Clonal (malignant) proliferation and accumulation of mature B-cells
- Involving blood/BMA/lymph nodes
7
Q
what is the epi. of CLL?
A
- 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»_space; Asia and Africa. Seen in all population groups
in South Africa. - Familial cases well described.
8
Q
what is the M:F ratio?
A
1.9: 1
9
Q
what is the clinical presentation of CLL?
A
- Asymptomatic with incidental raised WCC – due to lymphocytosis
* Up to 50% patients
* WCC > 10 x 109/L
* Abs lymphocyte > 4 x 109/L - 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
10
Q
HOW do we investigate or diagnose?
A
- cytometry
11
Q
what myeloma/ plasma cell myeloma?
A
- Plasma cell malignancy
- Monoclonal plasma cells
- Proliferate in bone marrow
12
Q
where do we look for plasma cells?
A
bone marrow aspirate and trephine
13
Q
what are the supportive investigations?
A
- To look for end organ damage
- Renal function
- FBC
- CMP
- Skeletal survey
14
Q
where do we look for paraprotein?
A
- urine
- blood
15
Q
conquences of paraprotein collection?
A
- Overabundance monoclonal paraprotein (M protein)
* Renal impairment - Destruction of bone
* Hypercalcaemia - Displacement of other hematopoietic cell lines
* Anaemia
* Neutropaenia
* Thrombocytopaenia
