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Cardio > Haematology Lymphoma > Flashcards

Haematology Lymphoma Flashcards

1
Q

Lymphoma types

A

40

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2
Q

3 types of lymphoma

A

Hodgkins lymphoma (15% of lymphoma)
Non-hodgkins lymphoma:
a. Low grade
b. High grade

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3
Q

Low grade examples

A

Follicular
Lymphoplasmacytoid
Marginal zone

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4
Q

High grade examples

A

Diffuse large cell lymphoma (most common) – 40%
Lymphoblastic lymphoma
Burkitts lymphoma

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5
Q

Hodgkins lymphoma: Epi

A

Male predominance
Incidence 6 per 100000
Peak incidence – young/adults

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6
Q

Hodgkins lymphoma:Association with

A

EBV infection

HIV infection

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7
Q

Hodgkins lymphoma: Clinical Features

A

Painless lymphadenopathy: contiguous spread.
Neck
Mediastinum
Axilla (usually above the neck)

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8
Q

Hodgkins lymphoma: B symptoms

A

Weight loss >10%
Sweats
Fever +33oC
Pruritis

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9
Q

Hodgkins lymphoma: ‘Patho-pneumonic’

A

Drink alcohol and lymph node hurts

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10
Q

Hodgkins lymphoma:Radiology can show

A

Hilar Lymphadenopathy
Differentials:
Sarcoid
Lymphoma

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11
Q

Hodgkins lymphoma: CT showing

A

Retoroperitoneal lymphadenopathy – enlarged lymphnodes in abdomen

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12
Q

Hodgkins lymphoma:Pet Scn

A

Glucose radioactive tracer. Assesses response

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13
Q

Hodgkins lymphoma: Histology

A

Lymphocyte poor
Nodular sclerosing
Mixed cellularity – slightly worse prognosis

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14
Q

Hodgkins lymphoma: Pathology characterised by

A

Presence of Reed-Sternberg cells

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15
Q

Hodgkins lymphoma: Investigation

A 
Investigation:
1.	Serum immunoglobulins
2.	Chest Xray
3.	Pet scan
4.	Lymph node biopsy
5.	U and E and LFT and LDH
Staging 
1.	Ct scan of abdomen and thorax
2.	Bone marrow trephine biopsy
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16
Q

Hodgkins lymphoma: Clinical Staging

A

Anarbour classification
1. Disease limited to single region of nodes or one extranodal site (IE)
2. Disease at two sites on some side of diaphragm
3. Disease at several sites on both sides of diaphragm (includes spleen, Waldeyers ring)
4. Spread of disease to extra lymphatic structures e.g. bone marrow, gut, lung, liver
A=no symptoms
B = Wt loss, sweats, fever
(IE) – Clump of nodes in bowel w/ lymph node

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17
Q

Hodgkins lymphoma: Treatment/Prognosis

A

Depends on stage

18
Q

Hodgkins lymphoma: Stage 1A-2A: treatment/prognosis

A

3-4 cycles of chemotherapy (eg ABVD) followed by radiotherapy to affected nodal areas.
Cure 80-90%

19
Q

Hodgkins lymphoma: Stage 2B-4B: treatment/prognosis

A

Combination chemotherapy alone (e.g. 6-8 cycles of ABVD)

Cure 60-80% (in young adults – worse inelderly +600

20
Q

Hodgkins lymphoma: ABVD combination and benefit

A

Adreiamycin
Bleomycin
Vinblastine
Dacarbazine

→ Fertility sparing

21
Q

Hodgkins lymphoma: Late complications of therapy

A
  1. Inferility
  2. Radiation pneumonitis and pulmonary fibrosis
  3. Secondary cancers including acute myeloblastic leukaemia
22
Q

Non-Hodgkins Lymphoma:Epi

A

Incidence has doubled over the past two decades
20/100000: increasing exponentially with age.
Rises to 70 cases per 100,000 in over 65s

23
Q

Non-Hodgkins Lymphoma: Description

A

More commonly disseminated disease at multiple sites and extra – lymphatic infiltration

24
Q

Non-Hodgkins Lymphoma: May be reflected by

A

Symptomatology e.g. presentation with neurological, gastrointestinal or respiratory symptoms or evidence of bone marrow infiltration (Anaemia) and circulating lymphoid cells in the blood.

25
Q

Non-Hodgkins Lymphoma: Two main Groups

A

Low grade

High grade

26
Q

Non-Hodgkins Lymphoma: Low grade lymphomas

A
  • Often-good response to chemotherapy but relapsing and remitting course.
  • Survival 7-10 years but only rarely disease – free long term.
  • Patients die from resistant disease, infection or transformation of lymphoma to high-grade disease.
27
Q

Non-Hodgkins Lymphoma: Low grade lymphoma Treatment

A

• 1. Wtch and see
• Single agent e.g. chlorambucil
• Combination chemotherapy
→R-CVP (Rituximab, cyclosphamide, vincristine, prednisolone)
→ Rituximab = humanised therapeutic monoclonal antibody (anti-CD20)

28
Q

Non-Hodgkins Lymphoma: Rituximab action

A

CD20 on the surface of B cells lymphocyte (B cells and T cells)

29
Q

Non-Hodgkins Lymphoma: High Grade Lymphomas

A

Aggressive and rapidly progressive course if untreated.

With combination chemotherapy, however, 65%, longterm survivale/care.

30
Q

Non-Hodgkins Lymphoma: High grade lymphoma treatment

A

Treat with an attempt to cure
Combination chemo: R-CHOP (rituximab, cyclophosphamide, Adriamycin, vincristine and prednisolone): 6-8 cycles

If partial remission or relapse, lower remission and cure rates (15%) with 2nd line therapy (platinum – based chem and stem cell autograft)

31
Q

Non-Hodgkins Lymphoma: Autograft

A

Own stem cells (rescue side effects from chemo vs. allograft (15-20% chance of death)

32
Q

Myelomatosis: Description

A

Malignant tumour involving proliferation of plasma cells which produce monoclonal immunoglobulin (paraprotein) and/or light chain (Bence Jones proteins)

33
Q

Myelomatosis: Epi

A

Disease of late middle age and elderly

34
Q

Myelomatosis: Clinical Features

A
  1. Marrow infiltration leading to anaemia
  2. Infections due to hypogammaglobuinaemia – redcued of autoantibodies
  3. Skeletal disease
    → Bone Pain
    → Pathological fracture
    → Hypercalcaemia
  4. Renal Failure
  5. Peripheral neuropathy
  6. Hyper-viscosity syndrome
Calcium
Renal failure
Anaemia
Bone pain
→ indication for treatment
35
Q

Myelomatosis: Hyperviscosity Syndrome

A

Confusion
Chest Pain
Vision disturbance

36
Q

Myelomatosis: Investigations

A
  1. Blood count, Very high ESR, plasma viscosity
  2. U and E, urea and serum calcium – deposition and damage in kidneys
  3. Serum immunoglobulins and urine for BFP (Bens jones)
  4. Bone marrow examination (>10% plasma cells) = myeloma definition
  5. Skeletal survey (or MRI scan) – osteolytic bone lesions in myeloma
37
Q

Myelomatosis: Blood Films show

A

Blood film showing rouleaux in myeloma

Stick blood – stacked together like coins: not diagnostic for myeloma

38
Q

Myelomatosis: Identification of monoclonal immunoglobulin

A

Serum protein electrophoresis

39
Q

Myelomatosis: Treatment general

A
  • Prompt treatment of infections
  • High oral fluid intake – support kidneys
  • Alllopurinol – prepare kidneys for onslaught of malignant cell breakdown
  • Bisphosphonate therapy (e.g. sodium clondrinate)
  • Plasmapheresis – hypoerviscosity
  • Management of renal failure and hypercalcaemia in acute situations
40
Q

Myelomatosis: Treatment Specific

A
  • Melphalan/prednisoone/thalidomide for elderly ptients
  • Cyclosphosphamide/thalidomide/dexamethasone for patients <65 years followed by peripheral blood stem cell autograft
  • Velcade and Revlimid used following relapse
  • Local radiotherapy to site of bone pain/fractures
41
Q

Myelomatosis: Prognosis

A 
Relapsing Remitting course
Eventually dur resistance occurs and long term survival/cure is rare
Mean survival:
•	3-5 years in older patients
•	5-7 years in younger group
•	(<65 yrs) intensively treated.

Low level paraproteins found in 3% of elderly individuals termed.
MGUS (monoclonal gammaopathy of undetermined significane). 10% will progress to myeloma over 10 years follow-up.

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