41 Lymphoma and myeloma Flashcards Preview

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Flashcards in 41 Lymphoma and myeloma Deck (25):
1

Describe the process of B cell differentiation:

Pro-B gains surface immunoglobulins to become naive B cell in bone marrow.
Then antigens are presented to it in a secondary lymphoid organ.
Last stage is NF-κB pathway.

2

Name the proteins found during electrophoresis of blood serum: (5).

Serum albumin.
Alpha-1 globulins.
Alpha-2 globulins.
Beta globulins.
Gamma globulins.

3

When is immunofixation performed and what does it detect/identify.

When an M spike is seen on protein electrophoresis.
Monoclonal immunoglobulins.

4

What is myeloma?

Malignant disorder of clonal plasma cells.

5

What is the epidemiology of myeloma?

70 years.
Higher in Afro-Carribeans.
Preceeded by asymptomatic MGUS.

6

What is MGUS?

Monoclonal gammopathy of uncertain significance.

7

What are the diagnostic criteria for a diagnosis of multiple myeloma?

Clonal bone marrow plasma cells or plasmacytoma and at least one CRAB/MDE feature.

8

What are the CRAB features of multiple myeloma?

HyperCalcaemia.
Renal insufficiency.
Anaemia.
Bone lesions.

9

What are MDE's (myeloma defining events)? (3).

> 60% clonal plasma cells on bone marrow biopsy.
SFLC ratio >100mg/L.
Bone marrow lesion >5mm.

10

Why does renal insufficiency occur in multiple myeloma?

Light chains clog the kidney.

11

What is the treatment for AKI in myeloma?

Steroids.

12

How is myeloma intensively treated? (3)

VCD.
GCSF.
Mephalan.

13

What are the diagnostic criteria for MGUS?

Serum M-protein under 30g/L
Under 10% clonal plasma cells in BM
Absence of CRAB features

14

What are the risks of progression from MGUS? (1,3)

1% per year, majority to myeloma.
Others to: Waldenstrom's macroglobulinaemia, primary AL amyloidosis, lymphoproliferative disorders.

15

What are the higher risk features for MGUS progressing? (3).

High M-protein level.
IgA/IgM rather than IgG production.
Abnormal SFLC ratio.

16

What is the pathology behind amyloidosis?

Light chain fragments misfold and self aggregate into β-pleated fibrils.

17

What does amyloidosis cause? (4).

Nephrotic-range proteinuria (mainly albumin).
Cardiac/liver problems.
Peripheral neuropathy.
End-stage renal failure.

18

What type of lymphoma is follicular lymphoma?

Non-hodgkin.

19

What is the genetic change in follicular lymphoma?
Effect?

Translocation t(14:18).
Brings bcl-2 under influence of immunoglobulin heavy chain gene. Over expression inhibits apoptosis.

20

What features of follicular lymphoma are bad for prognosis? (5).

> 60y/o.
Ann Arbor stage III or IV.
LDH above normal limit.
Hb less than 120g/L
Mor than 4 nodal sites.

21

What is Hodgkin lymphoma characterised by?

Presence of Hodgkin-Reed Sternberg cells within cellular infiltrate of non malignant inflammatory cells.

22

How do Hodgkin-Reed Sternberg cells evade apoptosis? (3).

Activation of NF-κB.
Incorporation of EBV.
Incorporation of latent membrane proteins (LMP1/2).

23

Which chemotherapy is commonly used for Hodgkin lymphoma?
Long term complications? (3).

ABVD.
Pulmonary toxicity, CVD, 2o malignancies.

24

What is M-protein?

Monoclonal immunoglobulin synthesised by plasma cells in myeloma.

25

What are the common causes of lymphadenopathy? (3)

Infections.
Autoimmune disease (SLE, serum sickness).
Neoplasias (lymphoma, leukaemia).

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