Myeloma and lymphoma Flashcards Preview

Clinical Pathology > Myeloma and lymphoma > Flashcards

Flashcards in Myeloma and lymphoma Deck (48):
1

where does the first stage of B cell differentiation take place

bone marrow.

2

what happens to B cells in the first stage of differentiation.

pro B cells form naïve B cells.
gain surface immunoglobulins
each B cell is committed to a single light chain (kappa or lambda)

3

what are 2 light chains in B cell called

kappa and lambda.

4

the first stage of B cell differentiation is also known as

antigen independent stage.

5

where does the second stage of B cell differentiation take place.

inside the lymph organs- lymph nodes

6

what is the second stage of B cell differentiation also known as

antigen dependent stage.

7

what happens in the second stage of cell differentiation

Mature naïve B cells develop into proliferating blast cells after encountering an antigen or T cell activation, and here they apoptose, become short-lived plasma cells or enter the germinal centre.

8

where does somatic hypermutation and heavy class switching occur

germinal centre in response to antigen presentation.

9

The process by which naïve B-cell blasts become either plasma or memory B-cells involve four steps which are

proliferation
immunoglobulin somatic hypermutation and class switching, selection and differentiation.

10

what protein is needed to form plasma blasts

NF-kB

11

what B cells which undergo somatic hypermutations are known as

centrocytes/ centroblasts.

12

define somatic hypermutation

A process by which the Mature B cells undergo mutation making them more or less specific to the antigen which they were presented with.
If the mutation is not favourable the cell will undergo apoptosis.

13

what molecule are immunoglobulins made up of

glycoprotein.

14

immunoglobulins are composed of how many polypeptide chains

two “light chains” and two “heavy chains”

15

what tip of bond holds the light and heavy chains of an immunoglobulin together

covalent disulphide bonds

16

what are the 5 main types of heavy chains

IgG, IgM, IgA, IgD, IgE-

17

define protein electrophoresis

laboratory technique whereby serum is placed in a gel and exposed to an electric current

18

what 5 major fractions are shown on a normal antibody electrophorus

Serum albumin
Alpha-1 globulins
Alpha-2 globulins
Beta glogulins
Gamma globulins- flat hump, with no peaks as all the immunoglobulin’s are produced in equal amounts.

19

When is immunofixation used

after the protein electrophoresis comes back with a M peak.

20

what does a immunofixation show

Enables the detection and identification of monoclonal immunoglobulins

21

define myeloma

incurable malignancy of plasma cells.

22

what form do all myelomas originate at

MGUS- monoclonal gammopathy of uncertain significance- abnormal spike on protein electrophoresis up asymptomatic.

23

what organ is commonly affected in myeloma

kidney
MGRS- monoclonal gammopathy of renal significance- so has renal dysfunction

24

define solitary plasmacytoma

group of plasma cells deposit e.g. in femur., not much myeloma in the bone marrow.

25

what is the name given to the worst form of myeloma

plasma cell leukaemia- full-blown myeloma with severe symptoms

26

what is the diagnostic criteria for myeloma.

Clonal BM plasma cells >10%( more than 10% neoplastic plasma cells in bone marrow) or biopsy-proven bony or extramedullary plasmacytoma AND any one or more of:
CRAB features
MDEs

27

what are CRAB features

– C- hypercalcemia (177 micrimol/L.
– A- anaemia Hb

28

what are the myeloma defining events.

– > 60% clonal plasma cells on BM biopsy
– SFLC (serum free light chain) ratio >100mg/L provided the absolute level of the involved LC is >100mg/L
– Light chains clog up the kidney.
– >1 focal lesion on MRI measuring >5mm

29

how is initial management of acute kidney injury with suspected myeloma carried out.
(what investigations need to be carried out)

• Blood film
• Electrophoresis
• Immunofixation
• Bone marrow biopsy with
• flow cytometry
• start on steroids- even before diagnosis.

30

what intensive therapy is provided for patients with myeloma

VCD-chemotherpay (given in 4 cyclic whilst you harvest patient stem cell)
GCSF- injections which helps spill stem cells form the bone marrow in t peripheral blood.
Melphalan-big chemotherapy dose resulting in neutropenia, reduced RBC and platelets and then they patient is regiven their stem cells to help them recover.

31

what is the function of treatment with GCSF

spill stem cells form the bone marrow in t peripheral blood.

32

what are the negative consequences of melphalan chemotherapy

neutropenia, reduced RBC and platelets

33

newer drugs from the treatment of myeoma

Daratumumab (antiCD138)
Carfilzomib (proteosome inhibitor)
Ixazomib (proteosome inhibitor)

34

what is the non-intensive therapy that is used to treat myeloma

• CDTa- given initially (a= attenuated)= attenuated chemotherapy.
• VCD- given next in small dose= aim of treatment is to prevent complications such as bone injury not cure.
• RD (oral chemotherapy)= given after CDTa and VCD until disease progression.

35

In what groups of people are non-invasive treatment for myeloma typically provided

elderly, immunocompromised.

36

what is the initial treatment given all all patients who have suspected myeloma even if it hasn't yet been confirmed

steroids

37

what are patients in remission treated with

oral chemotherapy- RD

38

what is the future of treatment of monoclonal antibodies

Targeted therapies
Individualised therapy
monoclonal antibodies

39

what condition is commonly associated with myeloma

AL amyloidosis

40

define AL amyloidosis

Amyloid light chain amyloidosis.
Neoplastic plasma cells secrete abnormal proteins which misfold and then accumulate in organs causing them to enlarge.
Light chain fragments misfold and self-aggregate to form beta-pleated fibrils

41

what are the complications of AL amyloidosis

Nephrotic-range proteinuria:
Mainly albumin
Small monoclonal light chain component
Cardiac and liver involvement in 30%
Peripheral neuropathy in 10%
end stage renal failure

42

how does follicular lymphoma commonly present

painful lump in eck

43

define follicular lymphoma

neoplastic disorder of lymphoid tissue.

44

how do you acquire follicular lymphoma

chromosomal translocation – t(14;18) – which brings the bcl2 protooncogene under the influence of the immunoglobulin heavy-chain gene leading to over-expression of the bcl-2 protein.

45

if follicular lymphoma equally present in both genders

yes

46

Follicular International Prognostic Index (FLIPI) can be used to prognosticate lymphoma:

• age >60 years
• LDH above the limit of normal at diagnosis.
• Hb

47

is follicular lymphoma a hodgkin or non hodgkin lymphoma

non- hodgkin lymphoma

48

In AL amyloidosis the light chains misfiled into what.

Light chain fragments misfold and self-aggregate to form beta-pleated fibrils