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Haematology and Immunology > Lymphoid Malignancy > Flashcards

Lymphoid Malignancy Flashcards

1
Q

What is the general presentation of lymphoid malignancies?

A 
Enlarged lymph nodes (lymphadenopathy) 
Extranodal involvement 
Bone marrow involvement 
Weight loss 
Fever 
Night sweats 
Pruritis 
Fatigue
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2
Q

What is acute lymphoid leukaemia?

A

Neoplastic disorder of lymphoblasts

Diagnosed by >20% lymphoblasts present in bone marrow

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3
Q

How does ALL typically present?

A

2-3 week history of bone marrow failure or bone/joint pain
Anaemia
Infection
Possible raised WCC

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4
Q

What is the treatment for ALL?

A 
Induction chemotherapy to obtain remission 
Consolidation therapy 
CNS directed treatment 
Maintenance treatment for 18 months 
Stem cell transplantation
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5
Q

What are the risk factors for ALL poor outcome?

A 
Over 60 
White cell count >300x10^9/L 
Immunophenotype 
Cytogenetics/ molecular genetics 
Slow/poor response to treatment
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6
Q

How is a diagnosis of chronic lymphoid leukaemia (CLL) made?

A

Blood>5x10^9/L lymphocytes
Bone marrow >30% lymphocytes
Characteristic immunophenotyping (B cell markers and CD5 positive)

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7
Q

What is the presentation of CLL?

A 
Either asymptomatic or gradual onset 
Lymphadenopathy
Bone marrow failure (anaemia, thrombocytopenia)  
Splenomegaly 
Fever and sweats 
Hepatomegaly 
Infections 
Weight loss
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8
Q

What are the associated findings of CLL?

A

Immune paresis (loss of normal immunoglobulin production)
Paraprotein band
Haemolytic anaemia

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9
Q

What is the staging for CLL?

A

Stage A - <3 lymph node areas
Stage B - 3 or more lymph node areas
Stage C - Stage B + anaemia or thrombocytopenia

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10
Q

What are the indications for treatment of CLL?

A 
Progressive bone marrow failure
Massive lymphadenopathy 
Progressive splenomegaly
Lymphocyte doubling time <6 months or >50% increase over 2 months
Systemic symptoms
Autoimmune cytopenia
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11
Q

What is the treatment for CLL?

A

None/supportive care/intravenous immunoglobulins
Cytotoxic chemotherapy e.g. fludarabine, bendamustine
Monoclonal antibodies e.g. Rituximab, obinutuzamab
Corticosteroids
Radiotherapy
Novel agents

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12
Q

What are the poor prognostic markers for 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
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13
Q

What is the general presentation of a lymphoma?

A

Lymphadenopathy/ hepatosplenomegaly
Extranodal disease
B symptoms
Bone marrow involvement

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14
Q

How are lymphomas assessed/staged?

A

Lymph node biopsy
CT scan
Bone marrow aspirate and trephine

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15
Q

What is Hodgkin lymphoma associated with?

A

Epstein barr virus

Familial and geographical clustering

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16
Q

What is the treatment for Hodgkin lymphoma?

A

Combination chemotherapy (ABVD)
Radiotherapy
Use of PET scan to assess response to treatment and to limit use of radiotherapy

17
Q

How are non-Hodgkin lymphomas classified?

A

Lineage (B cell or T cell)
Grade of disease
Histological features of disease

18
Q

What are the features of a low grade non-Hodgkin lymphoma?

A

Indolent, often asymptomatic
Responds to chemotherapy but incurable
Median survival varies by subtype

19
Q

What are the features of a high-grade non-Hodgkin lymphoma?

A

Aggressive, fast-growing
Require combination chemotherapy
Can be cured, but varies widely

20
Q

What are the most common subtypes of Non-Hodgkin lymphoma?

A 
Diffuse large B-cell lymphoma (High grade) 
Follicular lymphoma (low grade)
21
Q

What are monoclonal bands (paraproteins)?

A

Represent immunoglobulin production by a single clone of cells
Detectable in either serum or urine

22
Q

What is a myeloma?

A

Neoplastic disorder of plasma cells, resulting in excessive production of a single type of immunoglobulin

23
Q

What are the features of myeloma?

A

Bone disease (lytic bone lesions, cord compression, hypercalcaemia)
Renal failure
Bone marrow failure esp anaemia
Infections

24
Q

What is the treatment for myeloma?

A 
Chemotherapy (cyclophosphamide, thalidomide and dexamethasone, proteasome ihibitors, IMiDs, monoclonal antibodies)
Bisphosphonate therapy (zoledronic acid)
Radiotherapy 
Surgery 
Autologous stem cell transplant
25
Q

What are the stages of myeloma?

A

Stage 1 - serum beta 2 microglobulin <3.5, albumin >35
Stage 2 - not stage 1 or 3
Stage 3 - serum beta 2 microglobulin >5.5

26
Q

What is the staging for lymphoma?

A

Stage 1 one region
Stage 2 two regions on the same side of diaphragm
Stage 3 above and below diaphragm
Stage 4 extranodal disease

27
Q

What is the treatment fro non-Hodgkin lymphoma?

A

Combination chemotherapy (Anti CD20 monoclonal antibody and chemotherapy)

Haematology and Immunology (16 decks)

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