Haematology - 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?
young & middle aged
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
ann arbor
(new is lugano)
Which subtype of lymphoma is most likely to affect young women?
Nodular sclerosing Hodgkin’s
What type of chemotherapy is used in Hodgkin’s lymphoma?
ABVD
Adriamycin,bleomycin,vinblastine and dacarbazine
After how many cycles of chemotherapy for Hodgkin’s lymphoma should the FDG-PET be repeated to check response?
2
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 3 bad prognostic markers in CLL
LDH raised
CD38 +ve
11q23 del
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 and immunotherapy
R - rituximab
C – cyclophosphamide
H – doxorubicin hydrochloride
O – vincristine (which used to be called Oncovin)
P – prednisolone (a steroid)
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
genreally fatal as responds poorly to chemo
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
normal Mature B cell: CD19 positive, CD5 negative
normal mature T cell: CD19 negative, CD5 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
How can pre- and post-germinal centre CLL be differentiated?
VDJ sequencing
variability, diversity, and joining
Which mutation is associated with a particularly poor prognosis in CLL?
17p deletion (P53)
What is Richter’s syndrome?
Rare transformation of CLL to high grade lymphoma
2 signs of Richter’s transformation
elevated serum levels of lactate dehydrogenase, and rapidly enlarging lymph nodes.
give 2 drugs that can be used in CLL if p53 deletion
alemtuzumab
ibrutnib - 1st
Recall 3 good prognostic markers in CLL
hyper mutated Ig gene
low ZAP-70 expression
13q14 del
outline the stages of Binet staging
A- high WBC, less than 3 groups of enlarged lymph nodes, usually no treatment needed (watchful waiting)
B - more than 3 groups of lymph nodes
C - anaemia or thrombocytopenia
why is there an increased risk of infection in CLL
although lymphocytes are high, they are monoclonal so not useful for antibody production
normal B cells are suppressed = hypogammaglobulinaemia
1st line drug in CLL if p53 intact
FCR - Fludarabine, cyclophosphamide and rituximab
who does CLL tend to affect
old
caucasian
relatives has 7x risk
its an indolent leukaemia, typically picked up in blood test for something else
fastest growing human cancer?
burkitt’s lymphoma
whats an aggressive NHL. whats the treatment
diffuse large B cell
treat w Rituximab-CHOP (6-8 cycles)
R - rituximab
C – cyclophosphamide
H – doxorubicin hydrochloride
O – vincristine (which used to be called Oncovin)
P – prednisolone (a steroid)
