Introduction to Lymphoma and Myeloma

Question 1

What is lymphoma?

Answer 1

A cancer of the white blood cells

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

Question 2

What are the main functions of lymph nodes

Answer 2

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

Question 3

What is meant by primary lymph organs

Answer 3

Sites where stem cells can divide and become immunocompetent

Question 4

what is meant by secondary lymph organs

Answer 4

Sites where most of the immune responses occur

Question 5

What is the steps in which a lymphoma is formed

Answer 5

• 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

Question 6

How are lymphomas classified

Answer 6

• Hodgkin Lymphoma
• Non-Hodgkin lymphoma

Question 7

What are the warning signs of lymphoma

Answer 7

• 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

Question 8

How do we diagnose lymphomas

Answer 8

• Lymph node biopsy
• Histology analysis
• Immunophenotyping
• NGS
• FISH
• Flow Cytometry

Question 9

How are lymphomas classified and staged

Answer 9

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

Question 10

What are the causes of lymphomas

Answer 10

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

Question 11

What is Hodgkin lymphoma

Answer 11

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

Question 12

How can we diagnose Hodgkin lymphoma

Answer 12

Excisional lymph node biopsy

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

Question 13

How do we treat Hodgkin lymphomas and what is it prognosis

Answer 13

• Chemotherapy and radiotherapy
• Stem cell transplant

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

Question 14

How do we classify Non-Hodgkin lymphomas

Answer 14

• High grade
• Low grade
• High and low grade

Question 15

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

Answer 15

• Diffuse large B cell lymphoma
• Burkitt lymphoma

Question 16

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

Answer 16

• Marginal zone lymphoma
• Follicular lymphoma
• Mantle cell lymphoma

Question 17

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

Answer 17

T cell lymphoma (all subtypes)

Question 18

How do non-Hodgkin lymphomas present in patients

Answer 18

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

Question 19

What are the risk factors in non-Hodgkin lymphomas

Answer 19

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

Question 20

What are the causes of non-Hodgkin lymphomas

Answer 20

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).

Question 21

How do chromosome translations cause lymphoma

Answer 21

• 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

Question 22

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

Answer 22

• 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

Question 23

How is non-Hodgkin lymphoma diagnosed

Answer 23

• Immunophenotyping
• Cytogenetics - FISH
• Light chain restriction
• PCR

Question 24

How is non-hodgkin lymphoma treated

Answer 24

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

Question 25

What is multiple myeloma

Answer 25

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

Question 26

How does multiple myeloma present in patients

Answer 26

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

Question 27

What are the risk factors of multiple myeloma

Answer 27

• Obesity
• radiation exposure
• family history
• certain chemicals.

Question 28

What are the 3 clinical features of multiple myeloma

Answer 28

• 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)

Question 29

How is multiple myeloma diagnosed

Answer 29

• 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