Haematological Malignancies Flashcards
Define Lymphoma
A clonal proliferation of lymphoid cells. There are two types: Hodgkin and Non-Hodgkin.
What is the difference between Hodgkin and Non-Hodgkin lymphoma?
Reed-sternberg cells are seen in Hodgkin lymphoma.
Describe Reed-sternberg cells
Giant cells found with light microscope in biopsies. They are CD15 and CD30 positive
What cells are usually involved in low-grade lymphoma?
B cells
What cells are usually involved in high grade lymphoma?
T cells
What is the ‘lymphoma paradox’?
High-grade lymphoma is more curable than low-grade lymphoma
What are the histopathological classifications of lymphoma?
Mantle cell
Follicular
Marginal
Describe the epidemiology of Hodgkin lymphoma
Affects males more than females and most people are diagnosed between the ages of 15-34 or over 60
What are the types of Hodgkin Lymphoma?
Classical Hodgkin lymphoma
Nodular lymphocyte-predominant Hodgkin Lymphoma
What are the risk factors for classical Hodgkin lymphoma?
Past infection with EBV
Low Immunity - HIV, transplantation
Autoimmune disease
Family History
How might a person with classical Hodgkin lymphoma present?
Lymphadenopathy - neck, armpit, groin, mediastinum
B symptoms - fever, drenching night sweats, weight loss (>10% in last 6 months)
Pain after drinking alcohol in areas of the body that contain lymphoma
Characterise the fevers in Hodgkin lymphoma
Come and go, lasting from a few days to 2 weeks
What is the treatment for Hodgkin lymphoma?
Chemotherapy A - doxorubicin (adriamycin) B - bleomycin V - vinblastine D - dabarbazine
How does rituximab work?
Locks on to CD20, a target protein found in B cells, and triggers the body’s immune system to attack the cells and destroy them.
What is the molecular cause of Mantle cell lymphoma?
A gene translocation which leads to cells making too much cycling D1 which leads to uncontrolled growth.
How much would you expect Hb to rise with 1 unit of packed red cells?
10 Hb
What is the threshold for transfusion?
<70 g/dl
What are the risks of blood transfusion?
Immune reaction, circulatory overload, blood type/blood bag mismatch
What is irradiated blood and why is it required ?
Blood subjected to radiation to stop any remaining donor white blood cells dividing, to prevent TF-GvHD.
What is TA-GvHD?
Transfusion Associated Graft vs Host Disease. Donor white blood cells attack your own tissues.
What are the indications for using irradiated blood?
Hodgkin lymphoma, transplant including bone marrow transplant, specific chemotherapies e.g. Clabribine
What is the expected increment for one dose of platelets?
20-30 x 10(9)/L
What else should you ask about when considering whether to give platelets, other than the count?
Uraemia
Drug history
What are the risks of platelet transfusion?
Bacterial infection - because they are stored at room temperature
Transfusion reactions
TRALI (transfusion related acute lung injury)
Can develop antibodies to platelets
What are the laboratory findings in tumour lysis syndrome?
High phosphate, potassium, urate
Low calcium
What factors make patients at higher risk of developing tumour lysis syndrome?
High tumour burden: haematological malignancies, bulky chemo-receptive tumours Renal impairment Pre-treatment hyperuricaemia Hypovolemia - Pre-treatment diuretic use Pre-treatment LDH high
What are the symptoms of hypercalcaemia?
Constipation, abdominal pain, fatigue
N&V
Headaches, confusion
Polyuria, polydipsia
Define leukaemia
Increase in the number of white blood cells (clonal proliferation)
How are leukaemia’s classified?
Myeloid or lymphoid
Acute or chronic
What does ALL stand for?
Acute Lymphoblastic Leukaemia
Define ALL
Proliferation of lymphoid blasts (precursors of B or T cells)
Describe the symptoms of ALL
Pancytopenia
Bone and joint pain
Headaches
What diagnostic test would you order for All?
Bone marrow aspirate
What mutation is often involved in ALL?
Chromosome translocation 9:22 = philadelphia chromosome. Creates BCR-ABL gene.
What does AML stand for?
Acute Myeloid Leukaemia
What are the symptoms of AML?
Pancytopenia
Fever and sweats
Rarely: aching joints and bones, lymphadenopathy
What bloods should you order in a case of pancytopenia?
B12 and folate, ferritin
LDH
Urate
Coagulation screen
What are the risk factors for Hodgkin lymphoma?
Past infection with EBV
Low Immunity - HIV, organ transplant
Autoimmune disease e.g. RA, SLE
Family History
Define CLL
Increase in the number of mature lymphocytes (over 5 x 10^9/L)
What types of cells are most commonly involved on CLL?
B cells
What is MBL?
Monoclonal B lymphocytosis
Describe the presentation of CLL?
Asymptomatic OR Fatigue, SOB Lymphadenopathy Splenomegaly and hepatomegaly Repeated infections B symptoms
What would indicate a need for a shift from active monitoring to treatment?
Hb < 10 Plt < 100 Significant LN, massive Splenomegaly Doubling time < 6 months Infections Autoimmune
What would indicate a need for a shift from active monitoring to treatment?
Hb < 10 Plt < 100 Significant LN, massive Splenomegaly Doubling time < 6 months Infections Autoimmune
What would indicate a need for a shift from active monitoring to treatment?
Hb < 10 Plt < 100 Significant LN, massive Splenomegaly Doubling time < 6 months Infections Autoimmune
Which enzyme is increased in lymphomoproliferative disease?
Lactate dehydrogenase
How is treatment response measured in a patient with NHL?
LDH
