Haematology 2 - Lymphomas Flashcards
Describe the process it effects
Common lymphoid progenitor = small lymphocyte = B + T cells = plasma cell
Describe B cells
Exposed to soluble antigens = become sensitised to specific antigen
Further division = plasma cells = produce Abs to specific antigen
Memory cells = sensitised to antigen = dormant till next exposure = responsible for sustained immunity
Describe T cells
Recognise non-self cells
Helper T cells = recognise self vs non-self
Suppressor T cells = prevent hypersensitivity when exposed to non-self
Cytotoxic = lyse antigen cells
What are the clinical features of lymphomas?
Superficial lymphadenopathy = painless, asymmetric enlargement of one or more peripheral lymph nodes
Weight loss
Low grade fever
Night sweats
Alcohol induced pain (Hodgkin lymphoma)
Describe Hodgkin’s lymphoma
Characterised by Reed-Sternberg cells
Presents as localised disease in single group of nodes = good outcomes
Associated with constitutional B symptoms = low grade fever, night sweats + weight loss
Associated with Epstein-Barr virus
Bimodal distribution occurs in young adults + in over 55 years
Describe non-Hodgkin’s lymphoma
Broad spectrum of diseases with different characteristics + treatments
Majority B cell lineage, some T cell lymphomas
Often multiple lymph node involvement, extranodal involvement more common
May be associated with B symptoms (less often)
May be associated with viruses + autoimmune disorders
Occurs in children + adults
Describe the investigations
FBC
U+Es, LFTs + LDH
Immunoglobulin profile = lymphoma = compromised immunoglobulin
Associated with a virus = hepatitis, HIV, Epstein Barr virus
Imaging = contrast CT = need to check chemo working = if not = increase dose
Describe Ann Arbor Staging
Stage I = involvement of one lymph node
Stage II = involvement of 2 or more lymph nodes on same side of the diaphragm
Stage III = involvement of lymph nodes on both side of the diaphragm
Stage IIII = widespread disease
Describe diffuse large cell lymphoma
Most common non-Hodgkin
Abnormally large B lymphocytes that spread diffusely throughout biopsy specimen
Aggressive but may occur as low -grade lymphoma
Treatment = R-CHOP
Describe the International Prognostic Index (IPI) for aggressive NHL
Age >60
Ann Arbor stage III/IV
More than 1 extranodal site
Serum lactate dehydrogenase level above normal
ECOG performance 2 or above
Describe R-CHOP
Rituximab = IV infusion = before CHOP
Cyclophosphamide = IV infusion
Doxorubicin = IV bolus with saline
Vincristine = IV infusion in saline
Prednisolone = orally swallowed whole after food in morning
Repeat cycle every 21 days for MAX 8 cycles = fewer cycles = better prognosis
Describe Rituximab
MAb
Given 1st + at the end = works really well
Tumour lysis syndrome
Hypersensitivity reactions = antihistamines
Describe Cyclophosphamide
Alkylating agent
Toxicity to urinary tract = damage = associated with high doses = hydration
N+V
Describe Doxorubicin
Anthracycline
Cardiotoxicity = associated with cumulative exposure + in patients who already have cardiac conditions
Describe Vincristine
Vinca alkaloid
Constipation = PRN senna
Deaths associated with intrathecal administration
Describe Prednisolone
Targeted NOT supportive therapy
Would give metoclopramide + ondansetron as anti-emetics = don’t want to double up on steroids with dexamethasone
Lansoprazole for gastro-protectant
Describe the supportive therapies
Anti-emetic = metoclopramide + ondansetron = NO steroids
Prophylaxis tumour lysis syndrome = allopurinol
Lansoprazole = gastro-protectant with prednisolone
Hypersensitivity reactions = paracetamol + chlorpheniramine = Rituximab
Prophylaxis of urothelial toxicity (Cyclophosphamide) =manage infusion rate = start slow + increase up + hydration pre-chemo = Mesna used at higher doses
Describe Hodgkin’s lymphoma
B type lymphocytes
Reed Sternberg cells
2 or more large, acidophilic nuclei per cell = under microscope
Clonal B cells that lack typical B cell surface antigens
Evade apoptosis = accumulation of abnormal cells
Involves Epstein Barr Virus
Describe Hasenclever International Prognostic Index
Age >45
Male
Stage IV
Hg <10.5g/dl
WCC >16X109
Lymphocyte <0.6X109
Serum albumin <40g/l
Describe the treatment
Early favourable disease (Stages I-II) = 2 cycles of ABVD followed by interim PET scan + further 1-2 cycles ABVD +/-radiotherapy
Early unfavourable disease = 2x escalated BEACOPP + 2x ABVD followed by interim PET scan +/- radiotherapy
Advanced disease (Stages III-IV) = full course chemo (6-8 cycles), escalated BEACOPP or ABVD + interim PET
Describe chemo regime ABVD
Doxorubicin = IV bolus with NaCl
Bleomycin = IV infusion in NaCl
Vinblastine = IV infusion in NaCl
Dacarbazine = IV infusion in NaCl
Describe Bleomycin
Abx-cytotoxic agent
Lung damage = limit amount
Prescribe hydrocortisone IV before if NO dexamethasone in anti-emetic regime
Describe escalation/de-escalation of treatment
PET scan integral to management = staging + interim response to guide further treatment
PET positive = escalate more intensive treatment
PET negative = omitting radiotherapy or Bleomycin
What are the long term complications?
T cell defects
Secondary malignancies
CVD
Pulmonary toxicity
Thyroid dysfunction
Compromised fertility
