Haematological Malignancies - Non Hodgkins lymphoma Flashcards
What is the lymphatic system?
An integrated network of organs, tissues, cells and proteins
- Generative - thymus and bone marrow
- Peripheral
What is the role of the lymphatic system?
- Removes and destroys waste products
- Removes excess fluid from interstitial spaces
- Returns proteins and tissue fluids to blood
- Absorb fats + fat soluble vitamins and deliver to cells
- Important component of immune systems
What is the role of B lymphocytes
When exposed to soluble antigens it becomes sensitised to that specific antigen
there are 2 different types:
1. Plasma cells - produce antibody against specific antigen
2. Memory cells - sensitised to antigen but dormant until next exposure responsible for sustained immunity
What is the role of T lymphocytes
They recognise non self cells
there are 3 different types
1. Helper T cell - recognise self vs non self
2. Suppressor T cell - prevent hypersensitivity when exposed to non self
3. Cytotoxic T cell - lyse antigen cells
What are the 4 different types of lymphomas?
- Non Hodgkins lymphoma (NHL)
- Hodgkins lymphoma (HL)
- Childhood (X)
- Multiple Myeloma (MM)
What are the clinical features of NHL?
- Superficial lymphadenopathy (painless, asymmetric, enlargement of one or more peripheral lymph nodes)
- Weight loss - hypermetabolic state
- Fever
- Night sweats
- Dyspnoea (if oropharangeal/mediastinal nodes swell)
- Abdominal symptoms - hepatomegaly, splenomegaly
- Anaemia
- Neutropenia
- Thrombocytopenia
- Spinal chord compression - neurological symptoms
other organs effected - skin, brain, testes, thyroid, bone
What is the most common type of Non Hodgkins lymphoma?
Diffuse large B cell Lymphoma (DLBCL)
What is the origin of lymphomas?
T cell neoplasms
or
B cell neoplasms (most common)
What investigations can be taken to diagnose lymphomas?
Blood evaluation including lactate dehydrogenase
Biopsy
Imagine - PET-CT scan
Prognostic evaluation
What staging system is used in lymphomas?
Ann Arbour staging system
stage 1 - one lymph node are affected
stage 2 - multiple lymph node areas affected but on one side of diaphragm
stage 3 - multiple lymph node areas affected but on both sides of diaphragm
stage 4 - diffuse spread - not contained within lymph system anymore
What is the treatment of Diffuse large B cell Lymphoma (DLBCL)?
R-CHOP regimen (chemotherapy)
Describe the R-CHOP regimen for DLBCL
Day 1:
- IV Rituximab 375mg/m2
- IV Cyclophosphamide 750mg/m2 in 250 ml 0.9% saline over 30 mins
- IV Doxorubicin 50mg/m2 bolus via fast running drip of 0.9% saline
- IV Vincristine 1.4mg/m2 (max 2mg) in 50ml saline 0.9% over 10 mins
Day 1-4:
Oral Prednisolone 50mg/m2 (max 100mg) after food in the morning
ALL drugs given on 1st day then repeat this every 21 days for max of 8 cycles
What supportive therapy is given?
Anti-emetic - no steroid component (dex)
Prophylaxis of tumour lysis syndrome e.g., Allopurinol
Gastroprotection (lanzoprazole)
Pre-med for hypersensitivity reactions e.g. paracetamol and chloramphenamine
prophylaxis of urothelial toxicity - hydration pre chemo
What is Rituximab?
A monoclonal antibody therapy used in the R-CHOP regimen for DLBCL
It binds to CD20, a cell surface protein widely expressed on B cells
What are the common side effects of Rituximab?
Fever Malaise Nausea Vomiting Flushing Urticaria
