Lymphoid malignancies Flashcards
How can lymphomas present?
Enlarged lymph nodes (Lymphadenopathy)
Extranodal involvement
Bone marrow involvement
Systemic (B) symptoms - Weight loss >10% in 6 months, fever, night sweats, pruritis, fatigue
How is lymphoma diagnosed?
Biopsy to tell us the type
Clinical examination and imaging for staging
Malignancy in which cells causes acute lymphoblastic leukaemia?
Lymphoid progenitor/immature lymhpoid cells
Malignancy in which cells cause chronic lymhpoid leukaemia and lymphomas?
Mature lymphoid cells - B cells and T cells
What is non-hodgkin lymphoma?
Any lymphoma that isn’t Hodgkin lymphoma
What is ALL?
Cancerous disorder of lymphoid progenitor cells
What is the normal pathway of lymphoid progenitors?
Immature, rapidly proliferating cells differentiating into lymphocytes
What happens in leukaemia?
No differentiation, instead, rapid, uncontrolled growth and accumulation
Where does ALL usually present?
Usually in bone marrow but can be anywhere
How does ALL present?
2-3 week history of bone marrow failure or bone/joint pain
Weight loss
What is the most common form of ALL?
B-cell lineage
What blood counts would you expect from ALL?
Very low haemoglobin
Extraordinarily high white cell count
Low platelets
What are characteristics of malignant cells in ALL?
Large cells
Express CD19 marker -all B-cells have this
Express CD34 and TDT - markers of very early, immature cells
What is standard treatment for ALL?
Induction chemotherapy to obtain remission
Consolidation therapy
CNS directed treatment
Maintenance treatment for 18 months
Stem cell transplantation if high risk - adult patient
Bi-specific T-cell engagers (BiTe molecules) - blinatumumab
Chimeric antigen receptor T-cells
What is Chimeric antigen receptor T-cells treatment?
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
What are key side effects of CAR T-cell treatment?
Cytokine release syndrome - fever, hypotension, dyspnoea
Neurotoxicity
What are ALL poor risk factors?
Increasing age
Increased white cells
Cytogenetics/molecular genetics
Slow/poor response to treatment
What is Chronic lympoid leukaemia?
Mature lymphoid cells, grows slowly, requires a lymphocyte count >5
How does CLL typically present?
Often assymptomatic at presentation Bone marrow failure - anaemic/thrombocytopenic Lymphadenopathy Splenomegaly Fever and sweats Immune paresis Haemolytic anaemia
What is immune paresis?
Loss of normal immunoglobulin production
What staging system is used for CLL?
Binet system
What is stage A CLL?
<3 lymph node areas
What is stage B CLL?
3 or more lymph node areas
What is stage C CLL?
Stage B + anaemia or thrombocytopenia
