Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Systems: Haematology + Immunology > Lymphoid Malignancies > Flashcards

Lymphoid Malignancies Flashcards

1
Q

What does leukaemia actually mean?

A

White blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is lymphoma?

A

Cancer of lymphoid origin which can present with

  • Lympadeonpathy OR
  • Extranodal involvement OR
  • Bone marrow involvement

-Systemic B symptoms including weight loss (>10 % in 6 months), fever, night sweats, pruritus, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is lymphoma defined?

A

By the malignant cell characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What investigation tells us what type of lymphoma it is?

A

Biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What investigations tells us where the lymphoma is?

A

Clinical examination and imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is non-Hodgkin lymphoma?

A

A group of ~50 subtypes of lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can non-Hodgekin lymphoma be divided into?

A
  • High grade

- Low grade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give examples of lymphoproliferative disorders.

A
  • Acute lymphoblastic leukaemia (ALL)
  • Chronic lymphocytic leukaemia (CLL)
  • Hodgkin lymphoma
  • Non-Hodgkin lymphoma (NHL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a high grade non-Hodgkin lymphoma?

A

A diffuse large B cell lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How common is each type of lymphoma?

A

Most common

  • High grade NHL
  • Low grade NHL
  • Hodgkin lymphoma
  • CLL
  • ALL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is acute lymphoblastic leukaemia?

A

Neoplastic disorder of lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is acute lymphoblastic leukaemia diagnosed?

A

By >20% lymphoblasts present in bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the epidemiology of acute lymphoblastic leukaemia?

A
  • Incidence 1-2/100,000 population/year
  • 75% cases occur in children < 6 years
  • 75-90% cases are of B-cell lineage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does acute lymphoblastic leukaemia usually present?

A

Present with 2-3 week history of bone marrow failure or bon/joint pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the standard treatment for acute lymphoblastic leukaemia?

A
  • Induction chemotherapy to obtain remission
  • Consolidation therapy
  • CNS directed treatment
  • Maintenance treatment for 18 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What other treatment is there for acute lymphoblastic leukaemia?

A
  • Stem cell transplantation (if high risk)
  • Bispecifc T-cell engagers (BiTe molecules): e.g. Blinatumumab
  • CAR (chimeric antigen receptor T-cells)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is CAR treatment carried out?

A
  • Patient/ healthy 3rd party T-cells harvested
  • Transfected to express a specific T-cell receptor expressed on leukaemia cells (CD19)
  • Expanded in vitro
  • Re-infused into patient
18
Q

How does T-cell immunotherapy associated neurotoxicity present?

A
  • Confusion with normal conscious level

- Seizure, headache, focal neurology, coma

19
Q

How does T-cell immunotherapy associated cytokine release syndrome present?

A
  • Fever, hypotension, dyspnoea

- CAR T-cell effect correlated to presence of CRS (significant number require ITU support)

20
Q

What are poor risk factors associated with acute lymphoblastic leukaemia?

A
  • Increasing age
  • Increased white cell count
  • Immunophenotype (more primitive forms)
  • Cytogenetics/molecular genetics: t(9;22); t(4;11)
  • Slow/poor response to treatment
21
Q

What are the outcomes of acute lymphoblastic leukaemia?

A

Adults with ALL

  • Complete remission rate 78–91%
  • Leukaemia-free survival at 5y 30–35%

Children with ALL

  • 5y overall survival ~90%
  • Poor risk patients (slow response to induction or Philadelphia positive) 5y OS 45%
22
Q

What is the typical presentation of acute lymphoblastic leukaemia?

A
  • Bone marrow failure +/- raised white cell count

- Bone pain, infection, sweats

23
Q

How is chronic lymphoblastic leukaemia diagnosed?

A

-Blood > 5 x 109/L lymphocytes
-Bone marrow > 30% lymphocytes
-Characteristic immunophenotyping
(B-cell markers (CD 19, 20, 23) & CD5 positive)

24
Q

What is the incidence of CLL?

A
  • > 1700 new cases CLL per year in the UK
  • Commonest leukaemia worldwide
  • M:F 2:1
  • Occasionally familial
  • Rare in far East
25
Q

How does CLL present?

A

Often asymptomatic

Frequent findings

  • Bone marrow failure (anaemia, thrombocytopenia)
  • Lymphadenopathy
  • Splenomegaly (30%)
  • Fever and sweats (< 25%)

Less common findings:

  • Hepatomegaly
  • Infections
  • Weight loss
26
Q

What conditions/states are associated with CLL?

A
  • Immune paresis (loss of normal immunoglobulin production)

- Haemolytic anaemia (20% have positive direct antiglobulin test, 8% clinical evidence of haemolytic anaemia)

27
Q

What system is used to stage CLL?

A

Binet

28
Q

What are the stages of CLL according to the Binet system?

A

Stage A

  • <3 lymph nodes
  • Same survival as age matched controls

Stage B

  • 3 or more lymph node areas
  • ~8 year survival

Stage C

  • Stage B + anaemia ro thrombocytopenia
  • ~6 years survival
29
Q

What are the indications for treatment in CLL?

A
  • Progressive bone marrow failure
  • Massive lymphadenopathy
  • Progressive splenomegaly
  • Lymphocyte doubling time <6 months or >50% increase over 2 months
  • Systemic symptoms
  • Autoimmune cytopenias
30
Q

What is the treatment for CLL?

A
  • Often nothing: “watch and wait”
  • Cytotoxic chemotherapy e.g. fludarabine, bendamustine
  • Monoclonal antibodies e.g. Rituximab, obinutuzamab
  • Novel agents: (Bruton tyrosine kinase inhibitor eg ibrutinib) (PI3K inhibitor eg idelalisib) (BCL-2 inhibitor eg venetoclax)
31
Q

What are poor prognostic factors in CLL?

A
  • Advanced disease (Binet stage B or C)
  • Atypical lymphocyte morphology
  • Rapid lymphocyte doubling time (<12 mth)
  • CD 38+ expression
  • Loss/mutation p53; del 11q23 (ATM gene)
  • Unmutated IgVH gene status
32
Q

How does lymphoma present?

A
  • Lymphadenopathy/ hepatosplenomegaly
  • Extranodal disease
  • “B symptoms”
  • Bone marrow involvement
33
Q

How is lymphoma assessed and staged?

A
  • Lymph node biopsy
  • CT scan
  • Bone marrow aspirate and trephine
34
Q

What are the stages of lymphoma?

A

-Can be classified by presence of B symptoms

  • Stage 1= 1 node involved
  • Stage 2= 2 nodes
  • Stage 3= multiple nodes
  • Stage4= node and hepatosplenomegaly
35
Q

How is non-Hodgkin lymphoma classified?

A
  • Lineage (B-cell or T-cell) (Majority are B-cell in origin)
  • grade of disease (high grade or low grade)
  • Histological features of disease
36
Q

What are the features of low grade NH lymphoma?

A
  • Indolent, often asymptomatic
  • Responds to chemotherapy but incurable
  • Median survival varies by subtype
37
Q

What are the features of high grade NH lymphoma?

A
  • Aggressive, fast-growing
  • Require combination chemotherapy
  • Can be cured, but again varies widely
38
Q

Give examples of specific NH lymphoma disease entities.

A

Diffuse large B-cell lymphoma

  • Commonest subtype of lymphoma (of any kind)
  • High-grade lymphoma

Follicular lymphoma

  • 2nd commonest subtype of lymphoma
  • Low-grade lymphoma
39
Q

How is NH lymphoma treated?

A

Combination chemotherapy, typically anti-CD20 monoclonal antibody and chemo

40
Q

What is the epidemiology of Hodgkin lymphoma?

A
  • 30% of all lymphomas
  • Bimodal age curve with 1st peak at 15-35y and 2nd peak later in life
  • M:F 1.9:1
  • association with Epstein Barr virus; familial and geographical clustering
41
Q

What is the treatment for Hodgkin lymphoma?

A
  • Combination chemotherapy (ABVD)
  • +/- radiotherapy
  • Monoclonal antibodies (anti-CD30)
  • Immunotherapy (checkpoint inhibitors)
  • Use of PET scan to assess response to treatment and to limit use of radiotherapy

Systems: Haematology + Immunology (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions