Introduction to Lymphoma and Myeloma Flashcards

1
Q

What is lymphoma?

A

A cancer of the white blood cells

  • Affect stature blood cells mostly b but also t lymphocytes
  • Heterogeneous group of diseases
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2
Q

What are the main functions of lymph nodes

A
  • blood filtration/purification
  • removal of excess fluids from tissues
  • absorption and transport of lipids
  • Immune system activation
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3
Q

What is meant by primary lymph organs

A

Sites where stem cells can divide and become immunocompetent

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4
Q

what is meant by secondary lymph organs

A

Sites where most of the immune responses occur

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5
Q

What is the steps in which a lymphoma is formed

A
  • Affect lymphocytes in different maturation stages
  • Uncontrolled division
  • Organ size increase: Lymph node (adenopathy) Other lymph organs (splenomegaly)
  • Spread to other tissues through lymphatic system
  • Might infiltrate in bone marrow (detectable in blood) and/or other organs
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6
Q

How are lymphomas classified

A
  • Hodgkin Lymphoma
  • Non-Hodgkin lymphoma
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7
Q

What are the warning signs of lymphoma

A
  • Fever
  • Swelling of the face and neck
  • Lump in the neck, armpits or groin
  • Excessive sweating at night
  • Unexpected weight loss
  • Loss of appetite
  • Breathlessness
  • Feeling of weakness
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8
Q

How do we diagnose lymphomas

A
  • Lymph node biopsy
  • Histology analysis
  • Immunophenotyping
  • NGS
  • FISH
  • Flow Cytometry
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9
Q

How are lymphomas classified and staged

A

Stage 1: Localised disease, single lymph node
Stage 2: 2 or more lymph nodes on the same side of the diaphragm
Stage 3: 2 or more lymph nodes above and below diaphragm
Stage 4: Widespread disease, multiple organs with or without lymph node involved

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10
Q

What are the causes of lymphomas

A

Multifactorial disorder:

  • Malfunctioning of the body’s immune system
  • Exposure to certain infections e.g: HPV

The triggers remain unknown but most lymphomas occur when a B cells develops/acquires DNA mutations

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11
Q

What is Hodgkin lymphoma

A
  • Clonal B-cell malignancy
  • Presents as non-painful enlarged lymph nodes
  • Risk factors: EBV, Family history and HIV/AIDS
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12
Q

How can we diagnose Hodgkin lymphoma

A

Excisional lymph node biopsy

  • Reed-Sternberg cell is a hall mark of Hodgkin lymphoma
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13
Q

How do we treat Hodgkin lymphomas and what is it prognosis

A
  • Chemotherapy and radiotherapy
  • Stem cell transplant

5-year survival 50-90% depending on age and stage of histology.

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14
Q

How do we classify Non-Hodgkin lymphomas

A
  • High grade
  • Low grade
  • High and low grade
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15
Q

What characteristics are present in high-grade non-Hodgkin lymphomas

A
  • Diffuse large B cell lymphoma
  • Burkitt lymphoma
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16
Q

What characteristics are present in low-grade non-Hodgkin lymphomas

A
  • Marginal zone lymphoma
  • Follicular lymphoma
  • Mantle cell lymphoma
17
Q

What characteristics are present in high and low grade non-Hodgkin lymphomas

A

T cell lymphoma (all subtypes)

18
Q

How do non-Hodgkin lymphomas present in patients

A

Enlarged lymph node(s). Some forms are slow and others grow faster. General lymphoma symptom

19
Q

What are the risk factors in non-Hodgkin lymphomas

A
  • Virus infections e.g: EBV
  • Human T-cell leukaemia
20
Q

What are the causes of non-Hodgkin lymphomas

A

Chromosome translocations

  • Many lymphomas carry chromosome translocations involving the Ig heavy chain or light chain loci (chr14).
  • Ig genes are highly expressed in B- -cells.
  • Each Ig gene has a powerful tissue specific enhancer (high expression levels).
21
Q

How do chromosome translations cause lymphoma

A
  • Normally the enhancer activates the promoter of the rearranged V segment
  • The enhancer promotes gene expression of the BCL-2 gene an apoptosis inhibitor
  • Often observed in Burkitt’s lymphoma
22
Q

How is viral infections such as EBV a risk factor for lymphoma

A
  • It transforms B-lymphocytes in culture. Due to viral oncogene LMP-1
  • In highly immunosuppressed patients EBV transforms B-cells and are no longer eliminated by cytotoxic T-cells
  • Develop high grade lymphoma
23
Q

How is non-Hodgkin lymphoma diagnosed

A
  • Immunophenotyping
  • Cytogenetics - FISH
  • Light chain restriction
  • PCR
24
Q

How is non-hodgkin lymphoma treated

A
  • Chemotherapy
  • Radiotherapy
  • Stem cell transplant
  • Monoclonal Ab therapy -Rituximab (anti-CD20)
25
Q

What is multiple myeloma

A

Tumour of the bone marrow that involves plasma cells (antibodies production).

26
Q

How does multiple myeloma present in patients

A
  • Absence of initial symptoms
  • Later: bone pain
  • bleeding
  • frequent infections
  • anaemia.
27
Q

What are the risk factors of multiple myeloma

A
  • Obesity
  • radiation exposure
  • family history
  • certain chemicals.
28
Q

What are the 3 clinical features of multiple myeloma

A
  • Suppression of normal bone marrow, blood cell and immune cell function
  • Bone resorption and release of calcium (osteoclast activation via cytokines)
  • Pathological effects of the paraprotein –(single monoclonal Ig in the serum- high levels – malignancy)
29
Q

How is multiple myeloma diagnosed

A
  • Serum electrophoresis for paraprotein
  • Urine electrophoresis
  • Bone marrow biopsy for increased levels of plasma cells
  • Erythrocyte sedimentation rate (ESR)-high due to stacking of the RBC
  • Flow cytometry and cytogenetics to detect cause
  • Radiological investigation of skeleton for lytic lesions