Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

WEEK 10 SEM 4 > CLINICAL WORKSHOP- MYELOMA immunology > Flashcards

CLINICAL WORKSHOP- MYELOMA immunology Flashcards

(51 cards)

Start Studying
1
Q

What is the epidemiology of myeloma?

A

uncommon and accounts for 2% of all cases of cancer
It is the 2nd most common haematological cancer
It is about 10% of all haematological malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In the UK, how many new cases of myeloma are there per year?

A

about 5500 new cases of myeloma per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Who are most affected by myeloma?

A

age over 40
The peak average age at diagnosis is 65-70 years old
higher in men and African ethnicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why is myeloma often called multiple myeloma?

A

involves many lesions in the bone marrow

differentiates from a solitary tumour (plasmacytoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does myeloma originate?

A

mature B cell malignancy

in plasma cells of the BONE MARROW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where do B cells normally get activated?

A

germinal centres of the secondary lymphoid organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where do the mutated B cells accumulate?

A

in the bone marrow

proliferate there

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does monoclonal mean?

A

B cell can produce only one type of antibody

all mutated B cells create same antibody (MONOCLONAL B CELLS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are M proteins?

A

Antibodies secreted by the malignant B cells are called M proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can M proteins be?

A

full immunoglobulins
OR
immunoglobulin fragments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do normal plasma cells look like?

A 
terminally differentiated B cell
bigger than B cell
big nucleus
lots of cytoplasm
light area around the nucleus
eccentric nucleus (not in the middle)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does a B cell look like?

A

smaller than plasma cell
small nucleus
little cytoplasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is in the light area around the nucleus of the plasma cell?

A

ER

large golgi apparatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do plasma cells in multiple myeloma look like?

A 
excess plasma cells
plasma cells= multiple nuclei
Mott cells (in cytoplasm)= contain Ig
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the normal immunoglobin structure?

A

2 identical light chains

2 identical heavy chains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can the light chains of an Ig be?

A

kappa

lambda

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What can the heavy chains of an Ig be?

A 
Gamma, IgG
Mu, IgM
Alpha, IgA
Delta, IgD
Epsilon, IgE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which Ig has the highest serum level?

A

IgG (5-16g/L)
IgA (0.8-4g/L)
IgM (0.5-2g/L)
IgD and IgE= very low in healthy individuals except if allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the types of secretory myeloma?

A

−IgG secretory myeloma (55-60% cases)
−IgA secretory myeloma (20-25% cases)
−free light chain only secretory myeloma (20% cases)−IgD, IgE secretory myeloma is rare
−IgM secretory myeloma is very rare because most of the IgM lies on B cells before they are activated, and so it is usually secreted in low levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the immunological tests for myeloma detection?

A

serum protein electrophoresis

immunofixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does serum protein electrophoresis allow us to identify?

Study These Flashcards
A

monoclonal immunoglobin- CANT TELL WHAT CLASS AND WHAT LIGHT CHAINS PRESENT

22
Q

What is the process of electrophoresis?

Study These Flashcards
A
  1. load serum onto gel (on negative side)
  2. electrical fields is passed through gel
  3. negative proteins migrate to positive side
    DEPEND ON SIZE AND CHARGE
23
Q

What do proteins move depending on in electrophoresis?

Study These Flashcards
A

CHARGE: strongly negative proteins migrate faster to the positive side of the electrical field
SIZE: smaller proteins also migrate faster to the positive side of the electrical field

24
Q

What is the order of things seen in serum protein electrophoresis?

Study These Flashcards
A
  1. albumin band (THICKEST)- migrated furthest
  2. globulin alpha 1
    globulin alpha 2
    globulin beta 1
    globulin beta 2
  3. GAMMA GLOBULINS- NO BAND= FUZZY
25
What are gamma globulins?
``` circulating Igs (all classes of Ig) this area has no band= fuzzy area BC Igs are of different sizes, glycosylation etc. ```
26
What is densitometry scanning?
the bands are quantified onto a graph using computer software
27
How is the electrophoresis results different in a myeloma patient?
gamma band= ACC IS A BAND bc only 1 ANTIBODY is made
28
What does immunofixation allow us to see?
what type of Ig it is and what light chain
29
What is the process of immunofixation?
1. put serum on gel 2. gel has rabbit Ig anti-human Ig (antibodies against human IgG) 3. rabbit antibody binds to all Human IgG 4. Human IgG precipitates 5. gel is washed 6. when gel is washed all Ig except human IgG will wash out 7. run precipitate through electrophoresis 8. normal case: see fuzzy smear in IgG myeloma= will have dark band present 9. repeated with anti-human IgM, anti-human IgA, anti-human IgE, anti-human kappa light chain, and anti-human lambda light chain to determine the heavy and light chain
30
What are paraproteins/M proteins?
abnormal proteins | result from proliferation of one clone of plasma
31
What can paraproteins be?
full immunoglobins (light and heavy chains assembled together) full immunoglobin + free light chain just free light chains just heavy chains= VERY RARE
32
What are bence jones proteins?
paraproteins can be just free light chains low molecular weight can pass in urine
33
What shows multiple myeloma?
more than 30g/L immunoglobulin in serum or more than 60g/L immunoglobulin in urine fragmentation of immunoglobulins bc normal= fully assembled suppression of normal immunoglobulins will also indicate multiple myeloma
34
What malignant things can M proteins be in?
multiple myeloma waldenstrom's macroglobulinemia lymphoma chronic lymphocytic leukemia
35
What benign conditions can M proteins be present in?
MGUS (monoclonal gammopathy of undetermined significance)
36
What is the diagnostic criteria for myeloma?
any 2 of: −M protein/paraprotein in serum and/or urine −abnormal number of plasma cell, and increased number of plasma cells in the bone marrow −osteolytic lesions in bones
37
What are clinical symptoms of myeloma?
``` anaemia less wbc amyloid deposits in organs viscous blood high infection risk renal failure ```
38
How does a myeloma patient get anaemia?
``` malignant cells degrade bone more Ca2+ released more Ca2+ in serum malignant plasma cells compete with other cells developing in bone marrow so bone marrow is suppressed so you get anaemia and low WBC ```
39
Why does the blood become viscous?
lots or proteins in blood (M proteins)
40
How is renal failure caused?
small light chains pass in kidney, go to urine- block renal tubes= cause renal failure
41
Why do plasma cells in myeloma go malignant?
plasma cell DNA mutation - mutations in the proto-oncogenes that control the cell -cycle like cyclins - deletion of tumour suppressing genes eg TP53
42
What happens if there is rearrangement between the heavy Ig locus and proto-oncogenes at places in DNA?
- if there is a proto-oncogene which translocates into the immunoglobulin heavy chain locus, it may activate the immunoglobulin locus - if this proto-oncogene becomes a full oncogene, then it means the cell does not follow the usual rules of proliferation and the cell will become immortal and will refuse to die
43
What can mutations in the NF-Kappa-B transcription factor promote?
B cell survival
44
When is IL6 released?
produced by plasma cells produced by stromal cells in the bone marrow released when bone is destroyed IT PROMOTES THE GROWTH OF A MALIGNANT CELL
45
How does myeloma cause bones to break?
mutated myeloma cells produce growth factors (MIP- 1ALPHA) they interact with molecules present on stromal cell of bone marrow increase RANK ligand expression on stromal cells stromal cells ligate RANK on osteoclasts osteoclasts activated inhibit bone formation IL6 released= supports proliferation and survival of BAD plasma cell
46
What are the different reasons of kidney failure with myeloma?
``` hypercalcaemia excess production of light chains- toxic to renal tubular epithelial cells amyloid deposits in kidney infections hyperuricemia ```
47
What are the treatments of myeloma?
``` chemotherapy- control myeloma progression radiotherapy-localised bone pain bone marrow/stem cell transplantation IL6 inhibitor anti-angiogenic proteasome inhibitor- BORTEZOMIB bisphosphonate ```
48
What are examples of IL6?
thalidomide, lenalidomide
49
What do proteasomes do?
proteasome is an organelle inside cells= degrades unwanted and misfolded proteins it recognizes misfolded/bad proteins because these unwanted proteins are labelled with ubiquitin, and this is what the proteasome recognizes after breakdown, the cell reuses the amino acids to make new proteins
50
What do proteasome inhibitors do?
proteasome inhibitors act as a plug on the proteasome and block entry into the proteasome so now unwanted proteins cannot enter the proteasome because of this, unwanted proteins will begin to accumulate inside the cell and the cell will become apoptotic multiple myeloma produces a lot of proteins, and some of these molecules need to be degraded in the proteasome using these drugs blocks the proteasome, which makes them more sensitive to apoptosis, radiotherapy, and chemotherapy proteasome inhibitors also reduce the expression of RANK ligands on the stromal cells which inhibit activation of osteoclasts and thus reduce bone lysis−bisph
51
What do bisphosphonates do?
inhibit bone resorption, reduce fractures, and limit hypercalcemia, and stop destruction of bone mediated by malignant plasma cells

WEEK 10 SEM 4 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions