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HemOnc > 16 - Malignant lymphomas > Flashcards

16 - Malignant lymphomas Flashcards

1
Q

NOMENCLATURE OF MALIGNANCIES

A
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2
Q

DEFINITION OF LYMPHOMA

A

Any malignant clonal proliferation of lymphocytes
irrespective of whether it is called lymphoma or
leukemia

Example: Chronic Lymphocytic Leukemia, small
lymphocytic lymphoma

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3
Q

The M&M Analogy: Development
of a Clonal Cell Population

A
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4
Q

DEFINITION OF LYMPHOCYTE

A

Cells that mediate specific immune response.
We distinguish T lymphocytes from B lymphocytes.

T cells are defined by the presence of T cell
receptors, B cells are defined by the presence of
immunoglobulins.

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5
Q

ANY LYMPHOID TISSUE CAN GIVE RISE TO MALIGNANT LYMPHOMA!

A
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6
Q

lymphocyte to leukemia development analogy

A

Lymphocyte development is like a journey in a train
from one city to another. Anywhere along this journey the train can derail and an accident can occur. We call these accidents lymphomas or leukemias.

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7
Q

SIGNS AND SYMPTOMS OF LYMPHOMAS

A
  • Enlarged lymph nodes
  • Leukemia
  • Obstructing tumor mass
  • Displacement of normal marrow cells (anemia,
  • immunodeficiency, bleeding etc.)
  • Autoimmune hemolytic anemia
  • Tumor lysis
  • B-symptoms
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8
Q

TUMOR LYSIS SYNDROME

A
  • related to rapid turnover and destruction of cells
  • hyperkalemia (and associated arrythmias);
  • hypocalcemia;
  • hyperphosphatemia,
  • acidemia;
  • hyperuricemia (and uric acid nephropathy);
  • high LDH (may be >100X normal).
  • Prophylaxis and therapy with vigorous hydration and allopurinol. Monitor labs every 6-8 hours or more often as needed.
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9
Q

T cell differentiation/precursors and possible lymphomas

A
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10
Q

NORMAL LYMPH NODE

A
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11
Q

LYMPH FOLLICLE

A
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12
Q

New Cases of Cancer and Mortality USA 2022

A
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13
Q

Non-Hodgkin Lymphomas

A
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14
Q

Non hodgkins lymphoma
NATURAL HISTORY

A
  • heterogeneous
  • commonest presentation = painless peripheral adenopathy
  • 20% have systemic symptoms (compared with 40% in HL)
  • pattern of spread is unpredictable
  • extranodal sites more common than HL
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15
Q

non hodgkins lyphoma - natural history (continued)

A
  • Indolent lymphomas grow and spread slowly, respond to therapy (radiation +/- chemotherapy) but are rarely cured (e.g. SLL/CLL)
  • Aggressive lymphomas grow rapidly and may be cured with standard chemotherapy (+/- radiation). (e.g. Diffuse Large B Cell lymphoma)
  • Very aggressive lymphomas grow and spread very rapidly but are often cured with chemotherapy. Patients may die at the time of presentation or during therapy from tumor lysis syndrome or other complications. (e.g. ALL, Burkitt lymphoma)
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16
Q

NON-HODGKIN LYMPHOMA
ANN ARBOR STAGING

A
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17
Q

non hodgkins lymphoma - treatment

A
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18
Q

NON-HODGKIN LYMPHOMAS WE WILL
DISCUSS

A
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19
Q

Tdt and B-lymphoblastic morphology

A
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20
Q

LYMPHOBLASTIC LYMPHOMA VS
LYMPHOBLASTIC LEUKEMIA

A

= Precursor Lymphoblastic Leukemia/ Lymphoblastic Lymphoma

= Acute Lymphoblastic Leukemia

NOT REALLY DIFFERENT!

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21
Q

ACUTE LYMPHOBLASTIC LEUKEMIA,
CLINICAL

A
  • Splenomegaly
  • WBC is high with anemia and thrombocytopenia
  • problems related to cytopenias (bleeding, anemia,
    infections, fever)
  • rarely with symptoms related to hyperleukocytosis
  • two age peaks – pediatric – (2-5 yrs old) and adult
    (>50 yrs old)
  • children may be cured with standard therapy, adults are usually not cured without allogeneic stem cell transplantation
  • many develop tumor lysis syndrome
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22
Q

MANTLE CELL LYMPHOMA - morphology

A
23
Q

MANTLE CELL LYMPHOMA - diagnosis

A
24
Q

MANTLE CELL LYMPHOMA
CLINICAL

A
25
Q

diffuse large b-cell lymphoma

A

Most common of the aggressive lymphomas
* Middle aged adults
* Often present with adenopathy and splenomegaly; may have cytopenias particularly if marrow is involved
* May have B symptoms
* Circulating lymphoma cells may be indication for CNS therapy
* Tumor lysis syndrome may occur

26
Q

types of b-cell lymphomas

A
27
Q

SUMMARY: FOLLICULAR LYMPHOMA

A
28
Q

BURKITT LYMPHOMA - morphology and presentation

A
29
Q

SUMMARY: BURKITT LYMPHOMA

A
30
Q

BURKITT LYMPHOMA - CLINICAL

A
31
Q

Burkitts lymphoma - pathology/histology

A
32
Q

CHRONIC LYMPHOCYTIC LEUKEMIA

A
33
Q

EXTRANODAL GASTRIC MARGINAL ZONE LYMPHOMA OF MALT TYPE - histology

A
34
Q

EXTRANODAL MARGINAL ZONE B CELL
LYMPHOMA OF MALT TYPE - overview

A
  • Indolent B cell lymphomas confined to gastric
    mucosa
  • Also called extranodal marginal zone lymphoma
  • “Lymphoepithelial lesions”
  • Associated with H. pylori infection
35
Q

T cell lymphoblastic leukemia/ lymphoma

A
36
Q

MYCOSIS FUNGOIDES/SEZARY SYNDROME - histology and presentation

A
37
Q

MYCOSIS FUNGOIDES

A
38
Q

MYCOSIS FUNGOIDES/
SEZARY SYNDROME

A
  • Male>female
  • Median – 55 yrs old
  • Erythroderma, patches, plaques → tumors (may take yrs to make dx after initial skin rash is seen)
  • Sezary syndrome = leukemic phase
39
Q

CD20

A

Rituxan:**1. Mechanism of Action:

Rituxan is a monoclonal antibody that targets the CD20 antigen present on the surface of B cells.
It works by binding to CD20, leading to the destruction of B cells through various mechanisms, including antibody-dependent cellular cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC).
**2. Medical Conditions Treated:

Non-Hodgkin Lymphoma (NHL): Rituxan is commonly used in the treatment of various subtypes of NHL, including follicular lymphoma, diffuse large B-cell lymphoma, and others.
Chronic Lymphocytic Leukemia (CLL): Rituxan is used in combination with other agents for the treatment of CLL.
Rheumatoid Arthritis: Rituxan is used as part of a treatment regimen for moderate to severe rheumatoid arthritis in adults who have not responded to other disease-modifying antirheumatic drugs (DMARDs).

40
Q

Hodgkin Lymphoma

A

Hodgkin lymphoma differs from non-Hodgkin lymphoma because it has a specific kind of abnormal lymphocyte called a Reed-Sternberg cell. However, Reed-Sternberg cells make up only a small part of a Hodgkin lymphoma tumor, and the rest of the tumor is made of normal lymphocytes, which can cause inflammation.

41
Q

HODGKIN LYMPHOMA
EPIDEMIOLOGY & ETIOLOGY

A

Epstein-Barr virus/mono
* 4 per 100,000 per year in US
* Bimodal Age Distribution:
* 15-35 years old
* > 50 years old
* Male > Female

42
Q

HODGKIN LYMPHOMA
MORTALITY (1971-2016)

A
43
Q

HODGKIN LYMPHOMA
ANN ARBOR STAGING

A
44
Q

DIFFERENCES BETWEEN HL AND NHL

A
45
Q

HODGKIN LYMPHOMA SUBTYPES

A
  • Nodular lymphocyte predominant Hodgkin
  • Classical:
  • Nodular sclerosis classical
  • Mixed cellularity classical
  • Lymphocyte rich classical
  • Lymphocyte depleted classical
46
Q

WHO histological classification of hodgkin lymphoma

A
47
Q

Hodgkin Lymphoma:
Reed Sternberg Cell

A
  • Required for diagnosis of HD, it is the
    malignant cell
  • Large cell with at least two nuclei with
    prominent nucleoli
  • “Owl’s Eye” appearance
  • CD15+, CD30+
48
Q

SUMMARY: HODGKIN LYMPHOMA

A
49
Q

HODGKIN LYMPHOMA
CLINICAL FEATURES

A
  • Painless adenopathy
  • Fevers / night sweats /
    weight loss = (B symptoms)
  • Pruritis
  • Contiguous spread
  • Spleen, liver, marrow, …
50
Q

HOW DO WE DIAGNOSE LYMPHOMAS?

A
  • By morphology
  • Immunophenotyping by flow cytometry or
    immunohistochemistry
  • Cytogenetics and molecular studies (e.g. FISH,
    clonal IgH gene rearrangement, sequencing
    etc.)
51
Q

IGH GENE REARRANGEMENT BY PCR

A
52
Q

Next Generation Sequencing

NGS

A
53
Q

CD30

A

Adcetris is an antibody-drug conjugate (ADC). It consists of an anti-CD30 monoclonal antibody linked to a chemotherapy drug called monomethyl auristatin E (MMAE).
The antibody component targets CD30, a cell surface protein expressed on Hodgkin lymphoma and anaplastic large cell lymphoma cells.

HemOnc (29 decks)

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