Chronic Lymphocytic Leukaemia Flashcards
What is the typical presentation of lymphoma?
Painless progressive lymphadenopathy
- Palpable node
- Extrinsic compression of any “tube”: e.g. Ureter, bile duct, large blood vessel, bowel, trachea, oesophagus
Infiltrate/impair an organ system
- e.g. Skin rash, ocular and CNS, liver failure
Recurrent infections
Constitutional symptoms
Coincidental e.g. FBC, Imaging
What are the two broad classifications of B cell Non-Hodgkin’s Lymphoma?
Precursor B lymphoblastic leukaemia
Mature B lymphoblastic leukaemia
What are common types of B cell lymphoma?
Diffuse Large B-Cell Lymphoma (DLBCL)
Follicular NHL
CLL
What are the two broad classification of T cell lymphoma?
Precursor T lymphoblastic leukaemia or lymphoma (T-ALL)
Mature T and NK neoplasm
What are common types of T cell lymphoma?
PTCL
Anaplastic
Cutaneous
Summarise the epidemiology of Hodgkin’s Lymphoma.
- 1% of all cancer, 3:100,000 population
- HL is more common in males than females.
Bimodal age incidence:
- Most common age 20-29, young women NS subtype
- Second smaller peak affecting elderly >60 years old
What are signs and symptoms associated with lymphoma?
Painless enlargement of lymph node/nodes.
May cause obstructive symptoms/signs
Constitutional symptoms:
- Fever
- Night sweats
- Weight loss
- Pruritis and rarely alcohol induced pain
What are the four types of classical Hodgkin’s Lymphoma?
Nodular sclerosing
Mixed cellularity
Lymphocyte rich
Lymphocyte depleted
What is the most common type of Hodgkin’s Lymphoma?
Nodular sclerosing
80%
Good prognosis
Causes the peak incidence in young women
Which Hodgkin’s Lymphoma are rare?
Lymphocyte rich: Rare - Good prognosis
Lymphocyte depleted: Rare - Poor Prognosis
How common is mixed cellularity Hodgkin’s Lymphoma?
17% - uncommon
Good prognosis
How is Hodgkin’s Lymphoma staged and why is this important?
Following pathological diagnosis of a lymph node biopsy patients are ‘staged’ this has prognostic significance and also may determine the best approach for therapy.
FDG-PET/CT scan
Consider biopsy of other site if possibly infiltrated e.g. liver
What is the staging for Hodgkin’s Lymphoma?
Stage:
- I: One group of nodes
- II: >1 group of nodes same side of the diaphragm
- III: Nodes above and below the diaphragm
- IV: Extra nodal spread
Suffix A if none of below, B if any of below
- Fever
- Unexplained Weight loss >10% in 6 months
- Night sweats
What is the management for classical Hodgkin’s Lymphoma?
Combination chemotherapy - ABVD:
- Adriamycin
- Bleomycin
- Vinblastine
- DTIC
ABVD is given at 4-weekly intervals and is effective treatment. Preserves fertility (unlike MOPP the original chemo).
Can cause (long term):
- Pulmonary fibrosis
- Cardiomyopathy
How is chemotherapy administered in classical Hodgkin’s Lymphoma? What other management options are available?
Chemotherapy (essential for cure)
- ABVD 2-6 cycles (depends: stage and interim response)
- PET CT
- Interim: After x2 cycles, response assessment
- End of Treatment: Guides need for additional radiotherapy
n+/- Radiotherapy
Relapse (salvage chemotherapy)
High dose chemotherapy + Autologous PB stem cell transplant as support
Explain radiotherapy for classical Hodgkin’s Lymphoma.
Low/negligible risk of relapse
Risk of damage to normal tissue (collateral damage)
- Ca breast (risk 1:4 after 25 years)
- Leukaemia/mds (3%@10years)
- Lung or skin cancer
Combined modality (chemo + radio) is the greatest risk of 2o malignancy
What is the prognosis of classical Hodgkin’s Lymphoma?
Older patients generally do less well as do those with lymphocyte-depleted histology.
Prognosis:
Cure rate ranges from 50-90%.
Over 80% of patients with stage I or II disease are cured
Only 50% of stage IV patients are cured
What is Non-Hodgkin’s Lymphoma?
Neoplastic proliferation of lymphoid cells.
Incidence rising 200/million population/year
Clinical course highly variable :
- Fastest proliferating malignancy (Burkitt Lymphoma)
- Indolent diseases (eg Follicular NHL with a possible 25 year survival)
- Antibiotic responsive disease such as Gastric MALT