Leukemia, Lymphoma & Myeloma

by Peter Delves, PhD

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    00:01 Let us look at tumors of the immune system.

    00:04 Leukemia develops in the bone marrow.

    00:07 There are a number of different types of leukemia.

    00:11 The main ones are acute lymphoblastic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia and chronic myeloid leukemia.

    00:23 There are subtypes of each of these types of leukemia.

    00:28 Lymphomas in contrast develop in the lymphatic system.

    00:33 Two main lymphomas are Hodgkin lymphoma and Non-Hodgkin lymphoma.

    00:41 Myelomas are tumors of plasma cells.

    00:46 Here we have a stem cell that is giving rise to pre-B lymphocytes.

    00:54 Acute lymphoblastic leukemia is usually derived from immature pre-B cells.

    01:02 Blasts are present in the bone marrow and blood.

    01:05 In chronic lymphocytic leukemia and lymphoma, the malignant population is mature B-cells.

    01:14 In CLL, malignant cells are present in the blood.

    01:18 In lymphoma, the malignant cells are present in the lymph node and sometimes in other tissues.

    01:24 Plasma cells give rise to myeloma.

    01:28 In myeloma, the clone of malignant plasma cells produces a monoclonal immunoglobulin; in other words, all the antibody is absolutely identical because it’s derived from a malignant clone of plasma cell.

    01:45 T-cell malignancies are somewhat less common.

    01:49 T-cells are not infected by Epstein-Barr virus, which is a major way in which B-cells can become malignant.

    01:56 Also T-cells are somewhat more susceptible to apoptosis, and therefore less able to survive.

    02:06 There are also myeloid leukemias derived from myeloid progenitors as well as these lymphoid leukemias that you can see on this slide.

    02:17 Chronic lymphocytic leukemia is rather unusual, in that the leukemic cells have on their cell surface, a molecule that is normally present on B-cells, but also a molecule that is normally present on T-cells.

    02:31 As you can see in this flow cytometry diagram, there are normally CD19+ B-cells, and then separately CD5+ B-cells.

    02:45 However, in chronic lymphocytic leukemia, the cells express both of those molecules on their surface.

    02:51 In other words, a molecule that is characteristic of B-cells, but also a molecule that is more normally characteristic of T-cells.

    02:58 Post-transplant lymphoma can arise due to EBV infection in individuals that are receiving immunosuppression in order that they do not reject a transplanted tissue or organ.

    03:14 Prior to a renal transplant, this woman had memory T-cells responding to Epstein-Barr virus.

    03:21 The Epstein-Barr virus infection was controlled by the T-cells.

    03:26 However following a transplant, the immunosuppressive drug cyclosporine has made the memory cells non-responsive.

    03:35 And there is a polyclonal increase in EBV infected B-cells.

    03:42 There becomes a situation in which there is uncontrolled EBV infection which drives B-cell proliferation.

    03:55 The polyclonal B-cell proliferation will improve if the cyclosporine is stopped.

    04:01 However with ongoing proliferation, Myc translocation can occur within the B-cells.

    04:11 There is a malignant transformation resulting from this Myc translocation, and the development of lymphoma.

    04:20 The polyclonal growth of B-cells has increased the risk for this translocation to occur.

    04:26 The monoclonal B-cell proliferation will continue after cyclosporine is stopped, and the patient develops the symptoms of lymphoma.

    04:38 In multiple myeloma, there are plasma cells in the bone marrow that become malignant.

    04:47 And therefore, a clone of rapidly replicating plasma cells pumping out huge amounts of antibody of a single specificity develop.

    05:00 They produce what is referred to as a paraprotein.

    05:04 And this can be detected on a electrophoretic gel.

    05:07 We can see the paraprotein band in the gamma region from the patient on this gel.

    05:15 In contrast, in a healthy individual, that monoclonal band is missing because their antibodies are totally polyclonal; a very huge mixture of different specificities.

    About the Lecture

    The lecture Leukemia, Lymphoma & Myeloma by Peter Delves, PhD is from the course Tumor Immunology. It contains the following chapters:

    • Tumors of the Immune System
    • Chronic Lymphocytic Leukemia
    • Post-Transplant Lymphoma
    • Multiple Myeloma

    Included Quiz Questions

    1. EBV
    2. HPV
    3. HCV
    4. HIV
    5. CMV
    1. Lymphoma- myeloid progenitors
    2. Leukemia- myeloid progenitors
    3. Leukemia- lymphoid progenitors
    4. Myeloma- plasma cell progenitors
    5. Lymphoma- lymphoid progenitors
    1. CLL
    2. ALL
    3. T cell malignancy
    4. Myeloma
    5. Lymphoma
    1. Malignant plasma cells produce monoclonal antibody of a single specificity.
    2. Leukemic cells express molecules normally present on B and T cells.
    3. Malignant myeloid progenitors produce rapidly proliferating hematopoietic cells.
    4. An overproduction of immature B cells that can be detected in serum.
    5. Malignant thymic T cells that express tumor enhancing cytokines.

    Author of lecture Leukemia, Lymphoma & Myeloma

     Peter Delves, PhD

    Peter Delves, PhD

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