Haematology 12 - Lymphoma 2 Flashcards
How do Reed Sternberg cells appear on the blood film?
Giant cell surrounded by reactive eosinophils
What is the age distribution of Hodgkin’s lymphoma?
Females 20-29 (typically nodular sclerosing)
M=F, elderly
What are the symptoms of Hodgkin’s lymphoma?
Painless lymphadenopathy, that becomes painful on drinking alcohol
Constitutional B symptoms
If advanced lymphadenopathy, may –> obstructive symptoms
What is the cause of constitutional B symptoms in lymphoma?
Hyper-catabolic state
Which investigation is used to diagnose hodgkin’s lymphoma, and which diagnosis is used for staging?
Diagnosis: LN biopsy
Staging: FDG-PET
Recall the different stages of Hodgkin’s lymphoma
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
Which subtype of lymphoma is most likely to affect young women?
Nodular sclerosing Hodgkin’s
Nodular lymphocyte predominant Hodgkin’s mainly affects the elderly
What type of chemotherapy is used in Hodgkin’s lymphoma?
ABVD
All patients started on chemo even if stage1
This drug regimen preserves fertility
Patients considered for rituximab (anti-cd20) or nivolumab (PD1 inhibitor- increases anti-tumour activity of T cells) if they fail ABVD
After how many cycles of chemotherapy for Hodgkin’s lymphoma should the FDG-PET be repeated to check response?
After 2 cycles
And at the end of the treatment (outcomes of this will recommend if radiotherapy is needed or not)
What is the risk of giving radiotherapy for Hodgkin’s lymphoma?
It produces a lot of collateral damage, and when given alongside chemotherapy increases the risk of secondary malignany significantly
Recall 4 prognostic markers in lymphoma
- LDH
- Performance status
- HIV serology- increases risk of b-cell lymphomas due to underactive t-cells
- Hep B serology-immunotherapy regimens can lead to reactivation of virus and subsequent liver damage
How aggressive is diffuse large B cell non-Hodgkin’s lymphoma?
High grade
How aggressive is follicular non-Hodgkin’s lymphoma?
Indolent
How is diffuse large B cell non-Hodgkin’s lymphoma treated?
R-CHOP
Patients who relapse are considered for autologous stem cell transplantation (25% cure rate)
Aim of treatment is to cure
What mutation is commonly associated with follicular non-Hodgkin’s lymphoma?
t(14;18)
Translocation of Bcl2 –> oncogene
Which subtype of non-Hodgkin’s lymphoma is associated with chronic H. pylori?
Extra-nodal marginal zone lymphoma
What are the symptoms of extra-nodal marginal zone lymphoma?
Epigastric pain, ulceration and bleeding
How aggressive is enteropathy-associated non-hodgkin’s lymphoma?
Very aggressive
What is the main association of enteropathy-associated non-hodgkin’s lymphoma?
Coeliac
What finding on a blood film is typial of CLL?
Smear/ smudge cells
Recall the surface markers of intermediate B cells vs mature B cells vs CLL mature B cells
Intermediate B cell: CD5 positive
Mature B cell: CD19 positive
Mature CLL B cell: CD5 positive and CD19 positive
What are the 2 staging methods that can be used in CLL?
Rai staging
Binet staging
Is CLL a pre- or post-germinal centre malignancy?
50% pre, 50% post
How can pre- and post-germinal centre CLL be differentiated?
VDJ sequencing
Pre germinal centre-Unmutated VDJ= much worse prognosis
Which mutation is associated with a particularly poor prognosis in CLL?
17p deletion (TP53)
What is Richter’s syndrome?
Rare transformation of CLL to high grade lymphoma
Recall 3 classes of targeted therapy that can be given to treat CLL
- BCR kinase inhibitors (eg ibrutinib and idelalisib)- BCR Kinase important in B Cell signalling, blocking this results in B cell depletion
- BCL2 inhibitors (eg venetoclax)- promotes apoptosis
- CAR-T and other experimental cell-based therapies
What type of lymph node biopsy will help you diagnose lymphomas
Excision biopsy or core biopsy
Fine needle aspirate is useless- while not tell you anything because wont show you the structure of the lymph node. All the cells will just be smeared on the slide
Which of the Classical Hodgkin’s has a poor prognosis?
Lymphocyte depleted cHL
How to differentiate symptoms of HL and NHL
HL will have more contiguous spread with patients often presenting with mediastinal masses. NHL will be more widespread
Both will present with painless lymphadenopathy, B symptoms (except MZL) and compression symptoms, but in HL there might be painful lymph nodes after drinking
How is follicular non-Hodgkin’s lymphoma treated?
R-COP
Treatment is not curative
Watch and wait recommended first, only treat if clinically indicated (compression symptoms, painful nodes, recurrent infections)
Laboratory findings of CLL
Lymphocytosis (5-300 x 10^9)
Smear cells
Normocytic normochromic anaemia
Thrombocytopaenia
Cancer of mature b lymphocytes (pre and post germinal follicle)
Poor prognostic markers of CLL
CD38
pre-GC, IgH unmutated
17p(TP53) deletion
