Haem: Lymphoma 2, CLL and Lymphoproliferative disorder Flashcards
What are the two main subtypes of Hodgkin lymphoma?
- Classical Hodgkin Lymphoma
- Nodular lymphocyte predominant Hodgkin lymphoma
What is the fastest growing/aggresive human cancer?
Burkitt’s lymphoma
Describe the typical presentation of Non-Hodgkin’s lymphoma.
Painless lymphadenopathy
Compression symptoms
B symptoms
Which investigations may be used to stage lymphoma?
- PET scan
- CT scan
- Bone marrow biopsy
- Lumbar puncture (if CNS involvement)
What are some important tests to perform in non-Hodgkin lymphomae and why are they important?
- LDH - marker of cell turnover
- HIV serology - HIV can predispose to NHL (HTLV1 serology may also be important)
- Hepatitis B serology - NHL treatment may deplete B cells resulting in fulminant liver failure due to reactivation of hepatitis B in chronic carriers
Broadly speaking, what are the treatment approaches to non-Hodgkin lymphoma?
- Monitor only (in indolent lymphoma)
- Urgent chemotherapy
- Non-chemotherapy treatment (e.g. antibiotics to eradicate H. pylori)
What are the two most common types of non-Hodgkin lymphoma?
Diffuse large B cell lymphoma (DLBCL)
Follicular lymphoma
List some types of non-Hodgkin lymphoma that are:
- Very agressive
- Aggresive
- Indolent
-
Very agressive
- Burkitt’s lymphoma
- T or B cell lymphoblastic lymphoma/leukaemia
-
Aggressive
- Diffuse large B cell lymphoma
- Mantle cell lymphoma
-
Indolent
- Follicular lymphoma
- Small lymphocytic lymphoma (CLL)
- MALToma
What is the correlation between how aggressive a lymphoma is and how curable it is?
The more aggressive it is, the more curable
Indolent lymphoma is more likely to recur
What proportion of NHL are diffuse large B cell lymphoa
30-40%
Which factors are taken into account by the international prognostic index (IPI) for lymphoma?
- Age >60
- High LDH
- Performance status 2-4
- Stage III or IV
- More than one extranodal site
Which chemotherapy treatment is usually used for diffuse large B cell lymphoma?
- R-CHOP
- Rituximab
- Cyclophosphamide
- Doxorubucin
- Vincristine
- Prednisolone
NOTE: usually 6-8 cycles
NOTE: achieves a 50% cure rate
What treatment option may be considered for patients with diffuse large B cell lymphoma who relapse?
Autologous stem cell transplantation
What proportion of NHL is follicular lymphoma?
35%
Which genetic abnormality is associated with follicular lymphoma?
t(14;18) - resulting in over-expression of Bcl2 (which is an anti-apoptosis gene)
NOTE: follicular lymphoma is incurable but is indolent
What is the usual first-line treatment approach to follicular lymphoma?
Watch and wait
Only treat it clinically indicated (e.g. compression symptoms, massive nodes, recurrent infection)
Which chemotherapy regimen may be used in the treatment of follicular lymphoma?
- R-CVP
- Rituximab
- Cyclophosphamide
- Vincristine
- Prednisolone
Which lymphoid tissue tends to be affected by marginal zone lymphoma?
Extranodal lymphoid tissue (e.g. MALT)