Haematology 12 - Lymphoma 2

Question 1

How do Reed Sternberg cells appear on the blood film?

Answer 1

Giant cell surrounded by reactive eosinophils

Question 2

What is the age distribution of Hodgkin’s lymphoma?

Answer 2

Females 20-29

M=F, elderly

Question 3

What are the symptoms of Hodgkin’s lymphoma?

Answer 3

Painless lymphadenopathy, that becomes painful on drinking alcohol
Constitutional B symptoms
If advanced lymphadenopathy, may –> obstructive symptoms

Question 4

What is the cause of constitutional B symptoms in lymphoma?

Answer 4

Hyper-catabolic state

Question 5

Which investigation is used to diagnose hodgkin’s lymphoma, and which diagnosis is used for staging?

Answer 5

Diagnosis: LN biopsy
Staging: FDG-PET

Question 6

Recall the different stages of Hodgkin’s lymphoma

Answer 6

I: one group of nodes
II: >1 group of nodes, on one side of the diaphragm
III: Nodes on both sides of the diaphragm
IV: extranodal spread
Then:
A: no B symptoms
B: one/ any of fever/ weight loss/ night sweats

Question 7

Which subtype of lymphoma is most likely to affect young women?

Answer 7

Nodular sclerosing Hodgkin’s

Question 8

What type of chemotherapy is used in Hodgkin’s lymphoma?

Answer 8

ABVD

Question 9

After how many cycles of chemotherapy for Hodgkin’s lymphoma should the FDG-PET be repeated to check response?

Answer 9

2

Question 10

What is the risk of giving radiotherapy for Hodgkin’s lymphoma?

Answer 10

It produces a lot of collateral damage, and when given alongside chemotherapy increases the risk of secondary malignany significantly

Question 11

Recall 4 prognostic markers in lymphoma

Answer 11

1. LDH
2. Performance status
3. HIV serology
4. Hep B serology

Question 12

How aggressive is diffuse large B cell non-Hodgkin’s lymphoma?

Answer 12

High grade

Question 13

How aggressive is follicular non-Hodgkin’s lymphoma?

Answer 13

Indolent

Question 14

How is diffuse large B cell non-Hodgkin’s lymphoma treated?

Answer 14

R-CHOP and immunotherapy

Question 15

What mutation is commonly associated with follicular non-Hodgkin’s lymphoma?

Answer 15

t(14;18)

Translocation of Bcl2 –> oncogene

Question 16

Which subtype of non-Hodgkin’s lymphoma is associated with chronic H. pylori?

Answer 16

Extra-nodal marginal zone lymphoma

Question 17

What are the symptoms of extra-nodal marginal zone lymphoma?

Answer 17

Epigastric pain, ulceration and bleeding

Question 18

How aggressive is enteropathy-associated non-hodgkin’s lymphoma?

Answer 18

Very aggressive

Question 19

What is the main association of enteropathy-associated non-hodgkin’s lymphoma?

Answer 19

Coeliac

Question 20

What finding on a blood film is typial of CLL?

Answer 20

Smear/ smudge cells

Question 21

Recall the surface markers of intermediate B cells vs mature B cells vs CLL mature B cells

Answer 21

Intermediate B cell: CD5 positive
Mature B cell: CD19 positive
Mature CLL B cell: CD5 positive and CD19 positive

Question 22

What are the 2 staging methods that can be used in CLL?

Answer 22

Rai staging

Binet staging

Question 23

Is CLL a pre- or post-germinal centre malignancy?

Answer 23

50% pre, 50% post

Question 24

How can pre- and post-germinal centre CLL be differentiated?

Answer 24

VDJ sequencing

Question 25

Which mutation is associated with a particularly poor prognosis in CLL?

Answer 25

17p deletion (TP53)

Question 26

What is Richter’s syndrome?

Answer 26

Rare transformation of CLL to high grade lymphoma

Question 27

Recall 3 classes of targeted therapy that can be given to treat CLL

Answer 27

1. BCR kinase inhibitors (eg ibrutinib and idelalisib)
2. BCL2 inhibitors (eg venetoclax)
3. CAR-T and other experimental cell-based therapies