Haematological Malignancies Flashcards by Mairead Rocke

Define Lymphoma

A clonal proliferation of lymphoid cells. There are two types: Hodgkin and Non-Hodgkin.

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What is the difference between Hodgkin and Non-Hodgkin lymphoma?

Reed-sternberg cells are seen in Hodgkin lymphoma.

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Describe Reed-sternberg cells

Giant cells found with light microscope in biopsies. They are CD15 and CD30 positive

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What cells are usually involved in low-grade lymphoma?

B cells

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What cells are usually involved in high grade lymphoma?

T cells

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What is the ‘lymphoma paradox’?

High-grade lymphoma is more curable than low-grade lymphoma

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What are the histopathological classifications of lymphoma?

Mantle cell
Follicular
Marginal

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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

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What are the types of Hodgkin Lymphoma?

Classical Hodgkin lymphoma

Nodular lymphocyte-predominant Hodgkin Lymphoma

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What are the risk factors for classical Hodgkin lymphoma?

Past infection with EBV
Low Immunity - HIV, transplantation
Autoimmune disease
Family History

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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

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Characterise the fevers in Hodgkin lymphoma

Come and go, lasting from a few days to 2 weeks

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What is the treatment for Hodgkin lymphoma?

Chemotherapy
A - doxorubicin (adriamycin)
B - bleomycin
V - vinblastine
 D - dabarbazine

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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.

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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.

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How much would you expect Hb to rise with 1 unit of packed red cells?

10 Hb

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What is the threshold for transfusion?

<70 g/dl

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What are the risks of blood transfusion?

Immune reaction, circulatory overload, blood type/blood bag mismatch

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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