Hodgkins, Non Hodgkins, CLL

Question 1

Hodgkins Disease

Answer 1

Bimodal age - 20s then 60s
assoc: EBC and HIV
survival 85%
Dx: “B symptoms” - feverschillsnightsweats, pruritis, wt loss, alcohol induced pain
- Lymphadenopathy, contiguous spread, non tender, Moslty cervical LN, mostly mediastinal mass

Workup: Biopsy (no FNA), Labs, Radiology (CT, or PET), Bone marrow biopsy, Staging laparotomy (not anymore)
Staging: 1-4. 3=both sides of diaphragm, 4 is extranodal
A is asymptomatic, B is B symptoms, X is bulky mass
Reed Sternberg Cell - B cell origin, CD15+, CD30+

Tx: low stage are harder to treat
Stage 1/2 - Chemo + Radiation
Stage 3/4 - Chemo alone + radiation if bulky

Question 2

Non Hodgkins Lymphoma

Answer 2

Adults, Most are B cell, if T cell then be more aggressive
Etiology: Infections (EBV, HTLV, HCV, HHV-8, H Pylori)
Occupation/exposure (aggriculture, painter, machinist)
Chemotherapy or radiation

Work Up/Dx:
B symptoms: fevers, chills, night sweats, wt loss
LN/BM biopsy:
Lumbar puncture IF involvement of epidural, testicle, nasopharyngeal, or IF burkitts, lymphoblastic, HIV

Question 3

Which Non hodgkin’s lymphomas are
Indolent?
Aggressive?
Very Aggressive?

Answer 3

Indolent: follicular, mantle, small lymphocytic, MALT, Hairy cell, Splenic lymphoma
Aggressive: Diffuse large cell, Anaplastic large cell, Immunoblastic
Very aggressive: Burkitts, any T cell lymphoma

Question 4

Diffuse Large Cell Lymphoma (DLCL)

Answer 4

Most common NHL
Enlarging mass in nodes
all ages, mostly older though
Good IPI prognosis: even ok if 3+ bad factors

Tx: CHOP Chemo + Rituximab

Question 5

Indolent (low grade) lymphoma

Answer 5

enlarging lymph node over months to years
B symptoms are uncommon
Older ppl
Good survival
Incurable in advance stages

Tx:
Follicular: (stage 1/2): goal is to CURE, radiation therapy
Follicular: (stage 3/4): goal is to relieve, Radiation, chemo

Question 6

Very aggressive NHL

Answer 6

Lymphoblastic, Burkitt, any T cell lymphoma
Youth
treat like ALL (aggressive)

Tx:
Bone marrow and SC transplant
- for DLCL and very aggressive L. autologous SCT,
- Pnts who have relaplsed after CHOP
- This tx shows no evidence of working in indolent NHL

Question 7

MALT Lymphoma (mucosa assoc lymphoid tissue)

Answer 7

Could be anywhere, Indolent
H pylori + in 80% 
 - Tx: PPI/bismuth/amox/flagyl
H pylori - in 20%
 - Tx PPI/abx

Question 8

HIV associated Lymphoma

Answer 8

DLCL, Burkitt, CNS lymphoma assoc
HHV-8, and EBV assoc
Low CD4 counts is worse
Tx: HAART + CHOP-R

Question 9

Chronic Lymphocytic Leukemia

Answer 9

Most common leukemia
elderly
always B cell, always BOTH in peripheral blood and BM
Symptoms: usually asymptomatic, infection, fever, weak
Signs: Lymphadenopathy, Splenomegaly
Labs: High WBC, 
Low IgG, IgA, IgM in later stges
BM biopsy shows >40% mature lymphocytes

Start to tx when get anemic in stage 3 and thrombocytopenic in stage 4

Tx: NOT CURABLE
Chemo when stage 3 or 4, persistent symptoms