Haem: Lymphoma MDT Pt.3 Flashcards
List some types of T cell lymphoma and their associations.
- Adult T cell leukaemia/lymphoma - HTLV1
- Enteropathy-associated T cell lymphoma - Coeliac disease
- Cutaneous T cell lymphoma (mycosis fungoides)
- Anaplastic large cell lymphoma
Outline the typical presentation of anaplastic large cell lymphoma.
Children and young adults with lymphadenopathy
NOTE: this is aggressive
Outline the key histological features of anaplastic large cell lymphoma.
- Large epithelioid lymphocytes
- T cell or null phenotype (anaplastic)
Which molecular features are associated with anaplastic large cell lymphoma?
- 2;5 translocation
- Alk-1 protein expression - BETTER prognosis
List some key differences between Hodgkin and Non-Hodgkin Lymphoma.
- Hodgkin is more localised (usually one nodal site)
- Hodgkin spreads contiguously to adjacent to adjacent lymph nodes
NOTE: NHL tends to involve multiple lymph node sites and spread discontinuously
Outline the typical presentation of classical Hodgkin lymphoma.
- Young and middle-aged patients with only a single group of lymph nodes involved
- Associated with EBV
Name 3 subtypes of classical Hodgkin’s lymphoma
- Nodular sclerosing
- Mixed cellularity
- Lymphocyte rich and lymphocyte depleted
Which type of Hodgkin’s lymphoma is related to NHL
Lymphocyte predominant Hodgkins
What is the difference between a Hodgkin cell and a Reed-Sternberg cells
Hodgkin cell: mononucleated abnormal lymphocyte
Reed-Sternberg cell: bi- or multinucleated abnormal lymphocyte
Outline some histological features of classical Hodgkin lymphoma.
- Nodular sclerosis
- Mixed cell population of Reed-Sternberg cells and Hodgkin cells
- Lymphoma cells are few in number and are scattered around
- Eosinophils present
- Arise from germinal centre or post-germinal centre cells
What are the diagnostic markers for classic Hodgkin lymphoma?
- CD15
- CD30
(CD20 negative)
Describe the typical presentation of nodular lymphocyte predominant Hodgkin lymphoma.
- Isolated lymphadenopathy
- NO association with EBV
Outline the key histological features of lymphocyte predominant Hodgkin lymphoma.
- B cell rich nodules with scattered around L&H cells
- Arise from germinal centres
- Reactive population in the background consisting of small lymphocytes
- NO eosinophils and macrophages
Which markers are key in the diagnosis of lymphocyte predominant Hodgkin lymphoma?
- Positive = CD20
- Negative = CD15, CD30 (unlike classical Hodgkin lymphoma)
What constitutional symptoms may be present in a patient with lymphoma?
B symptoms - fever, night sweats, weight loss
Pruritis
What are the stages of lymphoma?
1 = 1 group of nodes
2 = > 1 group of nodes on the same side of the diaphragm
3 = > 1 group of nodes above and below the diaphragm
4 = extranodal spread
Suffic ‘B’ if B symptoms are present
Which type of scan is often used to stage lymphoma?
FDG-PET/CT
Which treatment modalities are used in Hodgkin lymphoma?
- All patients receive chemotherapy
- Radiotherapy is often used because Hodgkin lymphoma is very responsive
- Referred to as ‘combined modality’ if both are used
Which chemotherapy regimen is usually used for Hodgkin lymphoma?
ABVD: Adriamycin, Bleomycin, Vinblastine, Dacarbazine
NOTE: this is usually given at 4-weekly intervals for 2-6 cycles
What are some possible long-term consequences of chemotherapy for Hodgkin lymphoma?
Pulmonary fibrosis
Cardiomyopathy
How might a relapse of Hodgkin lymphoma be treated?
High-dose chemotherapy with autologous stem cell transplant
NOTE: intensifying chemotherapy will lead to an increased cure rate but it will also lead to an increase in secondary cancers
Describe the curability of Hodgkin lymphoma.
Stage I and II: >80%
Stage IV: 50%
