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Leila's Yr 5 Pathology > Haematology 5 - lymphoma 2 > Flashcards

Haematology 5 - lymphoma 2 Flashcards

1
Q

Radiotherapy dilemma in HL

A

Rdiotherapy can increase cure rate but more patients die of secondary malignancies

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2
Q

CD5+ and CD19+ cells

A

B-CLL, these cells should have switched off CD5

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3
Q

hODGKIN’S LYMPHOMA epidemiology

A

M>F (but more common in F in 20-30s)

Bi-modal: 20-29 most common then >60

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4
Q

Which subtype of HL is more common in females?

A

nodular sclerosing type

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5
Q

Where does HL arise f rom?

A

GC or post GC

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6
Q

Which virus is HL associated with?

A

EBV

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7
Q

Diagnostic markers for HL

A

CD30, CD15, CD20-ve

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8
Q

Most common type of HL

A

Nodular sclerosing

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9
Q

Classical HL with poor prognosis

A

Lymphocyte depleted

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10
Q

disorder of the elderly multiple recurrences (HL)

A

Nodular Lymphcoyte Predominant HL

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11
Q

Difference between NLPHL and Classical HL

A

Not associated with EBV
No eosinophils or macrophages
Can transform in to high grade B cell lymphoma (NHL)
Negative for CD30 + CD15, positive for CD20

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12
Q

Staging methods for HL

A

FDG-PET, CT, biopsy

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13
Q

In Ann Arbor staging, what is the spleen considered as?

A

One giant lymph node

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14
Q

Main complications of nodular sclerosing HL

A

SVCO, tracheal compression

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15
Q

1st line mx of HL (chemo)

A 
1st: ABVD
Adriamycin
Bleomycin
Vincristine
Dacarbazine

Given at 4-weekly intervals, preserves fertility

2nd: PET-CT –> Radiotherapy

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16
Q

Long term consequences of ABVD

A

Pulmonary fibrosis

Cardiomyopathy

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17
Q

Disadvantages of radiotherpay in HL

A

Collateral damage + increased risk of breast/lung/skin cancer, leukaemia, myelodysplasia

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18
Q

Mx of patients who relapse?

A

High dose chemotherapy + autologous SCT

3rd line: anti-CD30 +ANTI-PD1

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19
Q

wHAT % of HL patients will be long term survivors?

A

80%

20
Q

After 5 years post cure, patients more likely to die from…

A

secondary malignancy or CVS complications

21
Q

What is the fastest growing human cancer?

A

Burkitt’s

22
Q

Prognostic markers and important tests in NHL

A

Prognostic marker: LDH (marker of cell turnover), performance status
Important tests: HIV, HTLV-1 serology, hepB serology (treatment of NHL depletes B cells and if infected with HepB they can –> fulminant liver failure)

23
Q

Marginal zone lymphoma of the stomach = ?

A

MALToma

24
Q

Difficulty in treating indolent lymphomas

A

Go in to remission but tend to reoccur and when they do, less responsive to treatment

25
Q

System used to assess prognosis in DLBCL

A

IPI = international prognostic index

26
Q

Treatment of DLBCL

A 
6-8 cycles of R-CHOP
Rituximab
Cyclophosphamide
Adriamycin
Vincristine
Prednisolone
27
Q

If relapse after R-CHOP for DLBCL

A

Autologous SCT

28
Q

Translocaiton in follicular lymphoma and what does it lead to the overexpression of?

A

t(14;18), BCL-2

29
Q

Treatment of follicular lymphoma

A

It is incurable, at presentation you watch adn wait

If symptomatic e.g. obstruction –> R-CVP

30
Q

Casue of marginal zone lymphomas

A

Chronic antigen stimulation (they tend to be extra nodal and NOT associated with B symptoms)

31
Q

Characteristic of EATL

A

Aggressive but NOT that responsive to treatment

32
Q

Tdt CD19

A

CLL

33
Q

Mature b cells specifically express

A

CD19, sIg

34
Q

CD19 and CD5 status in normal mature B cells

A

CD19+ve, CD5-ve

35
Q

Normal mature T cells immunophenotyping

A

CD3, CD4, CD8, CD5+ve, CD19 -ve

36
Q

Mature B cells in cLL

A

CD19 and CD5 +Ve

37
Q

Staging used in CLL

A

Rai or Binnet

38
Q

3 stages in Binet staging

A 
A = <3 Lymphoid areas
B = >3 lymphoid areas
C = Hb <100g/L, plts <100x10^9/L
39
Q

Ig gene mutation status and prognosis

A

IgH mutated = good, unmutated = bad!!!

40
Q

If IgH mutated and unmated, where inthe lymphoid follicle do they arise from?

A 
Mutated = post-GC CLL
Unmutated = pre-GC CLL
41
Q

Most important deletion in CLL which is associated with bad prognosis

A

chromosome 17p deletion (TP53) –> LOSS OF P53 TSG

42
Q

Transformation in CLL

A

Richter’s transformation –> DLBCL

43
Q

Autoimmune disease associated with CLL

A

Warm AIHA

44
Q

Treatment of CLL

A

1) Supportive - vaccination (pneumococcus flu), anti-infective prophylaxis e.g. aciclovir, PCP prophylaxis, IVIG for those with hypogammaglobulinaemia and recurrent infections
2) mainly watch and wait
3) Richter’s transofrmation –> R-CHOP
4) Young pts allogenic SCT

45
Q

Indications for treatment in CLL

A 
Progressive lymphocytosis, count doubling <6 months
Progressive BMF (hB<100, Plts <100, neutrophils <1) , massive splenomegaly/lymphadenopathy, autoimmune cytopaenias (treat with steroids)
46
Q

Management of TP53/17p deleted CLL

A

1) ibrutinib (Bruton TKI) - refractory CLL p53mutation
2) venetoclax (bcl2 inhibitor)
3) CAR-T therapy

Leila's Yr 5 Pathology (100 decks)

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