Haematology- Lymphoproliferative Disorders Flashcards
Leukaemia?
Any type of cancer seen in the blood
Lymphoma?
Cancer of lymphoid origin
What are some of the symptoms of lymphoma?
Enlarged lymph nodes
Can be extranodal involvement
Can be bone marrow involvement
Weight loss, fever, night sweats, fatigue, pruitis
How are lymphomas/leukemia’s diagnosed?
Biopsies from either lymph node or bone marrow
How are lymphoma/leukemia’s staged?
Some sort of imaging, usually CT
What are the four most common lymphoproliferative disorders?
Acute lymphoblastic leukemia
Chronic lymphoblastic leukemia
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
What are the two divisions of non-Hodgkin’s lymphoma?
High grade
Low grade
What is the most common type of lymphoms?
Non-Hodgkin’s High-grade lymphoma
What happens in Acute lymphoblastic leukaemia?
Rapid, uncontrolled growth of lymphoid progenitor cells
Usually in bone marrow but they can go anywhere
Which age group is acute lymphoblastic leukaemia most common in?
Children
How does acute lymphoblastic leukaemia present?
2-3wk history of bone marrow failure or joint/bone pain
->typical history: young/young adult, impaired vision, weight loss, fatigue.
What is the treatment for acute lymphoblastic leukaemia?
Multi-agent intensive chemotherapy +/- allogeneic stem cell transplant
T-cell immunotherapy
What are some of side effects of T-cell immunotherapy?
Cytokine release syndrome- fever, hypotension, dyspnea
Neurotoxicity- confusion, headaches, focal neurology, coma
What are some of the factors which mean there is a poorer risk of recovery?
Increased age
Increased white cell count
Slow/poor response to treatment
->still 40% remission rate, but usually 90% approx.
Typical presentation of acute lymphoblastic leukaemia?
Bone marrow failure +/- raised white cell count
Bone pain, infection, sweats
What is the difference between acute lymphoblastic leukaemia and chronic lymphoblastic leukaemia?
Chronic lymphoblastic leukaemia grow a lot ore slowly, if at all.
Rarely needs treatment.
->requires a lymphocyte count >5 for diagnosis
How does chronic lymphoblastic leukaemia present?
Usually asymptomatic.
Frequent findings:
bone marrow failure, lymphadenopathy, splenomegaly, fever and sweats
Less common findings:
hepatomegaly, infections, weight loss
How is chronic lymphoblastic leukaemia usually found?
Incidentally, usually when looking at blood results
What are some of the associated findings in patients with chronic lymphoblastic leukaemia?
Immune paresis (loss of normal immunoglobulin production)
Haemolytic anaemia
Treatment for chronic lymphoblastic leukaemia
is not usually required.
What are some of the indications for treatment of chronic lymphoblastic leukaemia?
-Progressive bone marrow failure
-Massive lymphadenopathy
-Progressive splenomegaly
-Lymphocyte doubling time <6 months or >50% increase over 2 months
-Systemic symptoms
-Autoimmune cytopenias
Treatment, if required, for chronic lymphoblastic leukaemia?
Targeted treatments: ibruinib, idelalisib, venetoclax
What are the poor prognostic factors for chronic lymphoblastic leukaemia?
Genetic profile: p53 loss/mutation
Presentation of lymphoma?
Lymphadenopathy/ Hepatosplenomegaly
Extranodal disease
Weight loss, fatigue, fever (B symptoms)
Bone marrow involvement
How are lymphomas staged?
Lymph node biopsy
CT scan
Bone marrow aspirate
Which type of cell are the majority of Hon-Hodgkin lymphomas derived from?
B cells
What is the difference between low-grade and high-grade non-Hodgkin lymphomas?
Low grade lymphoma:
-Often asymptomatic
-Responds to chemotherapy but incurable
High grade lymphoma:
-Aggressive, fast-growing
-Require combination chemotherapy
-Can be cured
What is the most common high grade lymphoma?
Diffuse large B-cell lymphoma
Treatment of high-grade non-Hodgkin’s lymphoma?
Combination chemotherapy
At which ages are Hodgkin’s lymphoma most common?
1st peak at 15-35yrs
2nd peak later life
What are some of the associations of Hodgkin’s lymphoma?
Epstein Barr virus
Familiar link
Geographical clustering
Treatment of Hodgkin’s lymphoma?
Combination chemotherapy +/- radiotherapy
Monoclonal antibodies
Immunotherapy
->all of these apply to almost all lymphoproliferative disorders he said :)
Which investigation is important in the role of assessment to response to treatment in Hodgkin lymphoma?
PET scan
