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MD2 Medicine > Lymphoma and Myeloma > Flashcards

Lymphoma and Myeloma Flashcards

1
Q

What is significant weight loss?

A

10% of baseline

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2
Q

What questions on history would you ask if you suspected malignancy?

A 
FHx of malignancy
Past radiation/chemotherapy
Use of immunosuppressive agents for transplantation
Exposure to pesticides
Infections
- HIV
- HBV
- HCV
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3
Q

What symptoms may make you suspicious of a low platelet count?

A

Bruising
Bleeding when brushing teeth
Epistaxis

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4
Q

How large is the spleen usually on CT?

A

7-11 cm

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5
Q

What considerations are taken into account when deciding if a lymph node needs to be biopsied?

A

Significant enlargement
Persistent for >4-6 weeks
Progressive increase in size

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6
Q

Which type of biopsy is most useful for lymph nodes?

A

Excisional, rather than FNA

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7
Q

What is Richter’s transformation?

A

CLL transforms into large B cell lymphoma

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8
Q

What investigations are performed to stage a lymphoma?

A

Clinical history for B symptoms
PET scan
Bone marrow aspirate and trephine (BMAT)

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9
Q

What part of the body are PET scans not good at assessing in the context of malignancies?

A

Brain, because it uses a lot of glucose

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10
Q

What investigations are performed to enable treatment planning in lymphoma?

A 
Bloods
- FBE
- UEC
- LDH
Assessment of cardiac function - gated blood pool scan (GBPS)/echocardiogram
Assessment of viral status > give prophylaxis where appropriate
- HBV
- HIV
- CMV
- EBV
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11
Q

Why is cardiac function assessed before treatment is started for cancer?

A

Use of cardiotoxic chemoagents

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12
Q

What is the most common form of non-Hodgkin lymphoma?

A

Diffuse large B cell lymphoma (DLBCL)

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13
Q

What is the age distribution of DLBCL?

A

Incidence increases with age

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14
Q

How does DLBCL arise?

A

De novo

Transformation from lower grade disease

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15
Q

What is the treatment for DLBCL?

A

R-CHOP

  • Rituximab = anti-CD20 mAb
  • Cyclophosphamide = alkylating agent > damages DNA
  • (Hydroxy) doxorubicin = intercalating agent > damages DNA
  • (Oncovin) vincristine = binds to tubulin > prevents cell duplication
  • Prednisolone = corticosteroid
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16
Q

What does prophylaxis against tumour lysis involve?

A

Hydration > good glomerular filtration
Monitor electrolytes
Drugs to lower uric acid - allopurinol

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17
Q

What happens in tumour lysis?

A

High K
High phosphate
High urea

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18
Q

When is a high dose of methotrexate given as CNS prophylaxis in DLBCL?

A

Gonadal/BM involvement
High LDH
Has high risk of CNS disease

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19
Q

Is DLBCL curable?

A

In many patients, yes

20
Q

What is a low grade non-Hodgkin’s lymphoma?

A

Follicular lymphoma

21
Q

What is the treatment for follicular lymphoma?

A

Watch and wait

Chemotherapy +/- radiotherapy

22
Q

What grade is Burkitt lymphoma?

A

High grade

23
Q

What imaging may be required before biopsying a lymph node?

A

CT to assess extent and location
PET can be useful to determine which node to biopsy
US can be useful to biopsy superficial lymphadenopathy

24
Q

Why is an FNA never done when biopsying for suspected lymphoma?

A

Architecture critical for diagnosis of lymphoma

25
Q

What are the characteristic cells seen in Hodgkin lymphoma?

A

Reed-Sternberg cells

26
Q

What CD markers are positive in Hodgkin lymphoma?

A

CD15

CD30

27
Q

What staging regime is used to stage Hodgkin lymphoma?

A

Ann Arbor staging, like in DLBCL

28
Q

What percentage of lymphomas are Hodgkin lymphoma?

A

15%

29
Q

What age group typically gets Hodgkin lymphoma?

A

Bimodal distribution

  • Adolescents-young adults
  • Elderly
30
Q

Is Hodgkin lymphoma curable?

A

Over 70% curable

31
Q

How is treatment stratified in Hodgkin lymphoma?

A

According to

  • Stage
  • Site
32
Q

How do PDL inhibitors work?

A

PDL1 and PDL2 on tumour
PD1 and PD2 on T cells
Give mAbs that inhibit PDL > T cells remain active > kill tumour

33
Q

What is one of the side effects of PDL inhibitors?

A

Autoimmune disease

34
Q

When treating Hodgkin lymphoma, what should be considered as part of long-term management?

A

Minimisation of long-term toxicity

35
Q

In whom is monoclonal gammopathy of uncertain significance (MGUS) common?

A

Elderly

36
Q

What are the diagnostic criteria for MGUS?

A

Serum monoclonal protein low
Monoclonal bone marrow plasma cells <10%
No evidence of end organ damage due to clonal plasma cell disorder
No bone lesions on skeletal x-ray (if performed)
No clinical/lab features of amyloidosis/light chain deposition disease

37
Q

What are CRAB symptoms?

A 
C = Ca elevation in blood
R = renal insufficiency
A = anaemia
B = lytic bone lesions/osteoporosis
38
Q

What are the investigations of paraprotein?

A 
Bone marrow examination
Skeletal survey > look for lytic lesions
- Skull
- Spine
- Long bones
Spinal MRI if back pain/suspected cord compression
39
Q

What is smouldering myeloma?

A

Monoclonal protein in serum at 3+ g/100 mL OR monoclonal plasma cells 10+% in bone marrow/tissue biopsy
No evidence of end-organ damage due to clonal plasma cell disorder

40
Q

What is symptomatic myeloma?

A

Monoclonal plasma cells in bone marrow 10+% and/or biopsy-proven plasmacytosis
Monoclonal protein in serum and/or urine
Myeloma-related organ dysfunction
- At least 1 CRAB symptom

41
Q

How is myeloma treated?

A

Chemotherapy
Transfusions if anaemic
Bisphosphonates/denosumab +/- radiotherapy for bone disease

42
Q

What is the mechanism of action of denosumab?

A

RANK-L inhibitor

43
Q

What does treatment of bone disease in myeloma improve?

A

Symptoms, not overall survival

44
Q

What medical emergencies can occur due to myeloma?

A 
Hypercalcaemia
Spinal cord compression
Renal failure
Hyperviscosity
Infections
45
Q

What does initial chemotherapy for myeloma depend on?

A

Age
Stage
Comorbidities

46
Q

Is myeloma curable?

A

Considered incurable, except with allogeneic transplantation

- Not standard of care

47
Q

When should you suspect myeloma in a patient?

A

Fracture/bone pain without precipitating event
- X-ray shows lytic lesions/severe osteoporosis/crush fractures
Unexplained anaemia with rouleaux on blood film and high ESR
High total protein despite normal/low albumin
Unexplained hypercalcaemia
Unexplained renal failure

MD2 Medicine (18 decks)

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