Hodgkins, Non-Hodgkins, and Chronic Lymphocytic Leukemia Flashcards
hodgkins disease (HD) etiology:
- 10-15% of all lymphomas
- age: bimodal (20-30s and >50)
- more common in whites and males
- 85% survival
HD - B-symptoms
general symptoms 40% have:
-fevers -chills -night sweats
- pel-ebstein fever - twice day intermittent fever
- pruritus - ITCHING
- alcohol induced pain in LN
- WL
HD - lymphadenopathy:
70% cervical LN
60% mediastinal mass
30-40% spleen/para-arortic
non-tender!
HD work up?
- biopsy!
- Labs: CBC, LFT,ALP,LDH,ESR,Creat, B2MG
- radiology imaging: CT head to groin or functional study PET with radiolabed glucose
- bone marrow biopsy - unilateral
- staging laparotomy NOT DONE ANYMORE
HD staging:
1- 1 nodal region or lymphoid structure
2-2 or more nodal regions or contiguous extralymphatic sites on same side of diaphragm
3- 3 Both sides of diaphragm
4- >1 extranodal site (includes BM)
A-asymptomatic
B-Bsymptoms
X-bulky disease (>10cm or 1/3 width of mediastinum)
hodgkins classic malignant cell
redd-sternberg cell - its a B-cell!
HD - pathology:
1) Main=reed-sternberg cell
a) B-cell origin
b) CD15 and CD30 (DIAGNOSTIC)
c) comprises the minority of cels
2) histologic subtypes:
a) nodular sclerosis - MOST COMMON
- lymphocyte - reactive
- mixed cellularity
- lymphocyte depletion
worst pathology to see for HD?
lymphocyte depletion.. just have some reed sterns but no reactive lymphs
**curative therapy for hodgkins?
- *CHEMOTHERAPY!
* *MULTIPLE DRUG CHEMO!
Non-hodgkins (NHL) etiology:
- more common in men, whites, dev coutries
- older people except for two subsets (burkitt and lymphoblastic (ALL-like)
Hodgkins cell origin
always B-cell
Non hodgkins cell origin
mostly B but can also be t-cell
NHL related infections:
- EBV = burkitts and nasopharyngeal lymphoma
- HTLV-1 - adult t cell lymphoma/leukemia
- HCV, HHV8
- helocobacter pylori - gastric MALT lymphoma
most common cause of NHL?
prior chemotherapy and/or radiation
NHL work up?
same as HD (-biopsy! -Labs: CBC, LFT,ALP,LDH,ESR,Creat, B2MG -radiology imaging: CT head to groin or functional study PET with radiolabed glucose -bone marrow biopsy - unilateral -staging laparotomy NOT DONE ANYMORE)
- **EXCEPT:
- B-sx = fever, chills, NS, and WL ONLY
- LN biopsy and BM biopsy - flow cytometry, immunophenotyping and cytogenics
- lumbar puncture requried if: epiduar, testicular, nasopharyngeal involvment; burkitts, lymphoblastic, HIV lymphoma
2 most common NHL?
large cell (B, T, or ind cell) follicular (b-cell)
NHL classification:
1) Indolent (low grade) -
a) follicular
b) mantle cell
c) small lymphocytic
d) splenic lymphoma
e) MALT
f) hairy cell
2) Aggressive (intermediate grade)
a) diffuse large cell
b) anaplastic large cell
c) immunoblastic
3) very aggressive (high grade) (act like acute leukemia)
a) burkitts (small, noncleaved)
b) lymphoblastic or any t-cell lymphoma
Diffuse large-cell lymphoma (DLCL)
etiology:
1) 30% of all NHL
2) enlarging mass in nodal or extranodal site
3) frequently symptomatic from node of contritutional
4) occurs at all ages, more common >60
5) extranodal sites in 40%
6) median survival 4 yrs
7) overall cure rate 45%
8) most relapses occur within 3 years
International Prognostic index for DLCL - what are the prognostic factors?
worst status and best status?
- stage 3 or 4
- > 1 extranodal site
- age>60
- LDH elevated
- performance status 2-4
worst=3+ factors=55%4yr survival
best=0 factors =94% 4 yr survival
DLCL treatment?
- MUTLIDRUG CHEMO!
- -CHOP drugs - is curative
New standard of care for DLCL treatment?
CHOP + rituximab
rituximab is what kind of drug?
its an anti-CD20 antibody
monoclonal - very preferential!
indolent (low grade) lymphoma
- types?
- symptoms?
- when does it occur?
- what is most often presenting stage?
- median survival?
- follicular and small lymphocytic lymphoma
- enlarging LN over months to year and can come and – usually why 80% present with stage 3 or 4 (LIMITED TO LN, LIVER< SPLEEN AND MARROW)
- occurs middle to late age
- medial survival 6-12 years
- *-incurable in advanced stages** - these folks with late stages arent cured!
- 35-40% of follicular lymphoma will transform into DLCL at 10 years of disease - can become curable so it might not be a bad thing (richters transformation)
indolent lymphoma - treatment: goals:
-follicular stage 1/2 = goal is to cure; RT has 40-50% cure rate
(MOST PEOPLE HERE)-follicular stage 3/4 or SLL=goal is to relieve symptoms/promote longetivity; RT for large painful nodes; systemic therapy: constituation symptoms or cytopenias (CHOP like stuff)
TREAT WHEN DISEASE STARTS TO AFFECT THE PATIENT
