Stem Cell Differentiation and Multiple Myeloma
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Questions and Answers

What do pluripotent stem cells differentiate into?

  • Only proerythroblasts
  • Both myeloid and lymphoid stem cells (correct)
  • Only myeloid stem cells
  • Only lymphoid stem cells

Which cytokines are involved in the differentiation of multipotent myeloid stem cells?

  • IL11 and IL6
  • SCF and IL7
  • IL3, GM-CSF, and TPO (correct)
  • IL3 and EPO

What is the primary role of SCF in stem cell differentiation?

  • To promote myeloid differentiation exclusively
  • To act as a signaling molecule for lymphoid stem cells only
  • To inhibit differentiation
  • To support the proliferation of stem cells (correct)

Which of the following cell types is differentiated from a proerythroblast?

<p>Basophilic erythroblast (A)</p> Signup and view all the answers

Which cytokines are important for the differentiation of a lymphoblast?

<p>IL3 and IL7 (B)</p> Signup and view all the answers

What characterizes multiple myeloma?

<p>Proliferation of plasma cells (A)</p> Signup and view all the answers

Which of the following is a common clinical feature indicative of multiple myeloma?

<p>Lytic bone lesions on X-ray (C)</p> Signup and view all the answers

What is the median age for diagnosis of multiple myeloma?

<p>65 years old (A)</p> Signup and view all the answers

What type of proteins are found in increased concentrations in patients with multiple myeloma?

<p>Monoclonal proteins (C)</p> Signup and view all the answers

Which cells are primarily involved in the proliferation seen in multiple myeloma?

<p>Plasma cells (D)</p> Signup and view all the answers

What is the life expectancy (OS) typically associated with multiple myeloma?

<p>Around 5 years (C)</p> Signup and view all the answers

What is a systemic sign that may suggest multiple myeloma?

<p>Unexplained anemia (A)</p> Signup and view all the answers

Which types of cells are primarily involved in the immune response and are mentioned in relation to the characterization of multiple myeloma?

<p>Plasma cells and B lymphocytes (B)</p> Signup and view all the answers

What distinguishes multiple myeloma from other plasma cell pathologies?

<p>Detection of monoclonal protein (D)</p> Signup and view all the answers

Which of the following is a symptom that may indicate hypercalcemia?

<p>Drowsiness (A)</p> Signup and view all the answers

What can result from kidney damage associated with multiple myeloma?

<p>Acute renal failure (C)</p> Signup and view all the answers

What is the method used to confirm the presence of M-protein?

<p>Immunofixation of light chains (D)</p> Signup and view all the answers

Which stage of the diagnostic process is crucial to avoid negative impacts on multiple myeloma progress?

<p>Electrophoresis timing (B)</p> Signup and view all the answers

What does the presence of monoclonal protein (M) in serum or urine indicate?

<p>A form of monoclonal gammopathy (C)</p> Signup and view all the answers

Which protein type can be evident in the gamma, beta, or alpha-2 region during electrophoresis?

<p>Monoclonal protein (D)</p> Signup and view all the answers

What characterizes protein-M during serum protein electrophoresis?

<p>Single narrow tip (A)</p> Signup and view all the answers

What percentage of patients with multiple myeloma (MM) present with anemia at the time of diagnosis?

<p>73% (D)</p> Signup and view all the answers

Which symptom is noted to be present in approximately 5% of cases or less in patients with multiple myeloma?

<p>Paresthesia (A)</p> Signup and view all the answers

What clinical finding is associated with about 5% of multiple myeloma patients at diagnosis?

<p>Extramedullary plasmacytoma (C)</p> Signup and view all the answers

What triggers the bone pain in patients with multiple myeloma?

<p>Movement (D)</p> Signup and view all the answers

Which factor is not a predictor for kidney failure recovery in multiple myeloma patients?

<p>Age of the patient (D)</p> Signup and view all the answers

What is a common renal damage indicator in multiple myeloma patients at diagnosis?

<p>Cr &gt; 2 mg/dl (A)</p> Signup and view all the answers

Which condition is associated with myeloma leptomeningeal involvement?

<p>Abnormal CSF examination (C)</p> Signup and view all the answers

What percentage of multiple myeloma patients exhibit increased creatinine levels at diagnosis?

<p>48% (C)</p> Signup and view all the answers

What kappa/lambda ratio is indicative of monoclonality in bone marrow?

<p>4:1 or greater (C), 1:2 or less (D)</p> Signup and view all the answers

Which surface markers are typically expressed by myeloma plasma cells?

<p>CD79a, CD138, CD38 (C)</p> Signup and view all the answers

According to the Durie-Salmon criteria, which parameter is NOT part of Stage I criteria?

<p>Beta-2 microglobulin greater than 3.5 mg/l (C)</p> Signup and view all the answers

Which disease can monoclonal gammopathy be attributed to?

<p>Metastatic cancer (C)</p> Signup and view all the answers

What is a characteristic feature of normal plasma cells compared to myeloma plasma cells?

<p>Expression of CD45 (C)</p> Signup and view all the answers

What is a symptom that should be specifically checked during the clinical examination for multiple myeloma?

<p>Bone pain (A)</p> Signup and view all the answers

Which test is NOT a part of the standard investigations for diagnosing multiple myeloma?

<p>CT scan of the abdomen (B)</p> Signup and view all the answers

What morphological characteristic is associated with myeloma plasma cells?

<p>Spoke wheel chromatin (C)</p> Signup and view all the answers

What type of imaging is particularly useful for evaluating osteolytic lesions in multiple myeloma?

<p>MRI and PET-CT (B)</p> Signup and view all the answers

Which of the following tests can indicate the presence of monoclonal proteins in multiple myeloma?

<p>Serum immunofixation (D)</p> Signup and view all the answers

Which immune marker detection method is valuable for characterizing myeloma cells?

<p>Flow cytometry (D)</p> Signup and view all the answers

Which sign indicates an impending fracture in a multiple myeloma patient?

<p>Multiple osteolytic lesions (C)</p> Signup and view all the answers

What term best describes the appearance of cells in multiple myeloma that contain high levels of immunoglobulin?

<p>Mott cells (A)</p> Signup and view all the answers

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Flashcards

Pluripotent stem cell

A type of stem cell that can give rise to all blood cells.

Multipotent stem cell

A type of stem cell that can give rise to multiple types of blood cells within one lineage (e.g., red blood cells, white blood cells).

Multipotent myeloid stem cell

A specialized cell that can develop into different types of myeloid blood cells, like red blood cells, neutrophils, and macrophages.

Multipotent lymphoid stem cell

A specialized cell that can develop into different types of lymphoid blood cells, like B cells and T cells.

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SCF (Stem Cell Factor)

A specific factor that stimulates the growth and differentiation of pluripotent stem cells.

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B lymphocyte

A type of white blood cell that plays a key role in the immune system by producing antibodies.

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T lymphocyte

A type of white blood cell that is responsible for cell-mediated immunity, directly attacking infected cells.

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Basophile

A type of immune cell that is responsible for releasing histamine and other chemicals that cause inflammation.

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Neutrophil

A type of white blood cell that is the most abundant type and is responsible for killing bacteria and fungi.

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Eosinophil

A type of white blood cell that is responsible for killing parasites and other pathogens.

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Monocyte

A type of white blood cell that can differentiate into macrophages and dendritic cells.

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Multiple myeloma

A cancer of plasma cells, a type of white blood cell.

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Dendritic cell

A type of white blood cell that is responsible for presenting antigens to T cells.

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Multiple Myeloma (MM)

A type of cancer affecting plasma cells in bone marrow, leading to abnormal antibody production and various complications.

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Monoclonal Gammopathy

A condition where abnormal proteins (M-protein) are found in blood or urine, often produced by malignant plasma cells.

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Monoclonal Gammopathy of Undetermined Significance (MGUS)

A condition where M-protein is found, but no signs of full-blown MM, making treatment unnecessary.

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Serum Protein Electrophoresis

A test that separates proteins based on their size and charge, visualizing them as bands on special paper.

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Immunofixation

A test that identifies and quantifies specific antibody types present in a sample, by separating proteins based on their size and charge.

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M-protein

The presence of M-protein in serum or urine, a key feature of monoclonal gammopathies.

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Plasma cells

A type of bone marrow cell that makes antibodies, which are proteins that fight infections.

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Hypercalcemia

An increase in serum calcium levels, a common complication of multiple myeloma.

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Acquired Coagulopathy in Multiple Myeloma

A condition where monoclonal proteins block coagulation factors, leading to prolonged clotting time.

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Immunophenotyping

The process of identifying and classifying cells based on their unique surface markers and properties.

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Mature Myeloma Plasma Cells

Oval-shaped cells with abundant blue cytoplasm, a round nucleus, and a perinuclear halo.

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Russell Organelles

Abnormal structures within myeloma plasma cells that appear as small, round, dense granules.

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Mott (Morula) Cells

Cells that contain large, irregular, and vacuolated cytoplasm.

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Flame Cell

A type of plasma cell with an abundance of IgA and glycogen, giving it a distinctive morphology.

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Low Dose CT Scan

A technique used to evaluate the extent of osteolytic lesions, using a high-resolution imaging method

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Kappa/Lambda Ratio

The proportion of kappa to lambda light chains in bone marrow, typically around 2:1. Ratios outside this range (greater than 4:1 or less than 1:2) suggest a monoclonal gammopathy, a condition where a single clone of plasma cells is overproducing antibodies.

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Reactive Plasmocytosis

A condition where plasma cells exhibit an abnormal kappa/lambda ratio but do not meet the criteria for multiple myeloma. This can be caused by various factors such as autoimmune diseases, infections, or cancer.

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Plasma Cell Dyscrasia

The abnormal proliferation of plasma cells, often seen in multiple myeloma.

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International Staging System (ISS) for Multiple Myeloma

A staging system used to classify the severity of multiple myeloma based on factors like laboratory tests, clinical symptoms, and bone marrow involvement.

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Anemia in Multiple Myeloma

Anemia is a common symptom in multiple myeloma, caused by the displacement of normal red blood cells by cancerous plasma cells in the bone marrow.

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Bone Pain in Multiple Myeloma

Bone pain, especially in the lumbar or thoracic area, is frequently experienced by patients with multiple myeloma. This is due to the cancerous plasma cells infiltrating and damaging the bones.

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Kidney Damage in Multiple Myeloma

Increased creatinine levels in the blood indicate kidney damage, often a complication of multiple myeloma. This may occur due to myeloma cast nephropathy or amyloidosis nephropathy.

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Extramedullary Plasmacytoma

Extramedullary plasmacytoma is a tumor of plasma cells that develops outside the bone marrow. This rare occurrence may affect the spinal cord, leading to complications like spinal cord compression.

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Pulmonary Involvement in Multiple Myeloma

A rare complication of MM, this involves the infiltration of plasma cells into the lung tissue, causing respiratory problems. It typically occurs in advanced stages.

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Hypercalcemia in Multiple Myeloma

Hypercalcemia is a condition where there is an abnormally high level of calcium in the blood. This can be a complication of multiple myeloma due to the breakdown of bone by the cancerous plasma cells.

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Weight Loss in Multiple Myeloma

Weight loss is a symptom often observed in multiple myeloma, and it is usually unexplained and significant. It arises from factors like bone destruction, decreased appetite, and metabolic changes.

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Fatigue/Weakness in Multiple Myeloma

Fatigue and weakness are commonly experienced in patients with multiple myeloma. They stem from various factors like anemia, bone pain, and kidney dysfunction.

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Study Notes

Chronic Lymphoproliferative Disorders II

  • Chronic lymphoproliferative disorders (CLPs) are a group of conditions marked by continuous proliferation of lymphoid cells.

Lymphocyte Development

  • The provided diagram illustrates lymphocyte development, highlighting various stages and their associated regulatory factors (e.g., IL-3, GM-CSF, SCF).
  • This intricate process shows the differentiation of pluripotent and multipotent stem cells into different types of lymphocytes, including T cells, B cells, and natural killer (NK) cells.
  • Different cytokines play a role at each step of development.

Monoclonal Gammopathies

  • Monoclonal gammopathies are characterized by the presence of a monoclonal protein (M-protein) in serum or urine.
  • M-protein originates from a single clone of plasma cells, indicative of a proliferative disorder.

Multiple Myeloma

  • Multiple myeloma (MM) is a rare and incurable neoplasia (cancer).

  • It's characterized by neoplastic plasma cell proliferation, monoclonal immunoglobulin production, bone structure destruction (osteolytic lesions), and frequently-occurring kidney damage.

  • The median age for diagnosis in the EU is 68

  • Approximately 1% of all cancers are multiple myeloma

  • Common presenting features of MM include:

    • Bone pain with lytic lesions (on X-ray)
    • Increased total serum protein concentration
    • Presence of monoclonal protein (M-protein) in urine or serum
    • Systemic symptoms (e.g., anemia, hypercalcemia, acute renal failure)

  • Low life expectancy (OS ~ 5 years)

  • Distinguishing MM from other plasma cell pathologies is vital, as some conditions don't require therapeutic intervention.

  • Timely diagnosis of MM is critical due to its negative impact on disease progression.

Monoclonal Gammopathies

  • In many cases of monoclonal gammopathies, the presence of M-protein is the key diagnostic criterion.
  • The M-protein is visible as a distinct band on protein electrophoresis, often within the gamma, beta-2, or alpha-2 region.
  • Immunofixation further clarifies the protein's type.
  • In some rare cases, two M-proteins may be detected.

CLL (Chronic Lymphocytic Leukemia)

  • Chronic Lymphocytic Leukemia (CLL) is characterised by an abnormal increase of B lymphocytes in the blood.
  • CLL is primarily diagnosed between ages 50 and 70 years, often progressing indolently.
  • CLL frequently has features of abnormal white blood cells, but also has distinct markers like B-cells (CD19+ CD5+ ).
  • Key aspects that are important to diagnose CLL include blood lymphocyte analysis and bone marrow analysis including immunophenotyping.
  • This condition involves a malfunction in programmed cell death, leading to the accumulation of abnormal cells.

CLL Diagnosis and Treatment

  • Peripheral blood with lymphocytosis (>5000/mmc), presence of B lymphocytes with a typical nucleus structure, including smudge cells and abnormalities in bone marrow analysis are important in diagnosis.
  • Different staging systems exist to guide CLL treatment.

CLL Treatment

  • Indications for CLL treatment depend on the presence and severity of symptoms, as well as specific markers.
  • The presence of B symptoms, advanced-stage disease, rapid progression, and other factors determine the need for treatment.
  • Treatment options include both chemotherapy and targeted therapy.

CLL Complications

  • Autoimmune hemolytic anemia, infections, and various complications may result from prolonged CLL.
  • Treatment strategies and complications vary considerably, depending on the characteristics of individual cases.

Treatment Goals in Multiple Myeloma

  • Treatment aims to achieve a balance between short-term treatment response and long-term outcome and quality of life.
  • Continuous regimens are needed to manage the disease effectively without excessive toxicity while preserving quality of life.

Multiple Myeloma Treatment Options

  • Treatment protocols for MM should consider individual patient profiles to effectively achieve optimal therapeutic outcome.
  • These vary depending on indicators of disease status, and on other patient-related factors, notably age, frailty, and comorbidities.

Baseline Evaluation

  • Crucial elements of baseline evaluation include assessing both disease-related and patient-related factors—such as performance, status and disease severity. Factors like genetic mutations or circulating plasma cells, or extramedullary disease are important. Further, age, renal function, organ comorbidities, compliance, and patient willingness should be assessed.

Natural History in Multiple Myeloma

  • Multiple myeloma has stages, from initial diagnosis (NDMM) and symptomatic (MM) and/or smoldering (SMM) disease to different periods of relapse, including early and refractory relapse- and triple/penta-refractory, when other forms of treatment are unsuitable—leading to survival considerations.

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Chronic Lymphoproliferative Disorders II PDF

Description

This quiz focuses on stem cell differentiation mechanisms, particularly pluripotent and multipotent stem cells. Additionally, it covers the clinical features and characteristics of multiple myeloma, including cytokines involved in the differentiation processes and common signs associated with the condition.

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