Lymphoid Malignancy

Question 1

what are the four main lymphoid malignancies?

Answer 1

acute lymphocytic leukaemia
chronic lymphocytic leukaemia
Hodgkins lymphoma
Non-hodgkin’s lymphoma

Question 2

how is acute lymphocytic leukaemia diagnosed?

Answer 2

> 20% lymphoblasts in bone marrow

Question 3

what is the presentation of ALL?

Answer 3

bone pain
B symptoms - weight loss, sweats, fever, night sweats, itch
bone marrow failure

Question 4

what are three signs of bone marrow failure?

Answer 4

anaemia
thrombocytopenia
bleeding
neutropenia

Question 5

what investigation can be used to diagnosis ALL?

Answer 5

biopsy

Question 6

what is the treatment for ALL?

Answer 6

steroids 
induction chemo 
CNS directed treatment 
maintenance treatment 
stem cell transplantation (if high risk)

Question 7

state some poor prognostic indicators for ALL?

Answer 7

increased age 
increased WCC
immunophenotype 
cytogenetics (t(9;22))
slow response to treatment

Question 8

what does ALL stand for ?

Answer 8

acute lymphocytic leukaemia

Question 9

what location does ALL occur?

Answer 9

bone marrow

Question 10

what location does CLL occur?

Answer 10

lymph nodes

Question 11

is ALL fast or slow growing

Answer 11

fast growing

Question 12

is CLL fast or slow growing ?

Answer 12

slow

Question 13

is CLL curable ?

Answer 13

no

Question 14

what is the location of CLL?

Answer 14

lymph nodes and blood

Question 15

what is the three criteria for CLL diagnosis ?

Answer 15

blood >5x10^9 lymphocytes 
bone marrow >30% lymphocytes 
characteristic immunophenotyping 
- B cell markers (CD 19, 20, 23)
- CD5 +

Question 16

what gender is CLL more common?

Answer 16

males

Question 17

what is the commonest leukaemia ?

Answer 17

CLL

Question 18

state the common presentation of CLL?

Answer 18

often asymptomatic

- incidental finding

Question 19

state some symptoms of CLL?

Answer 19

bone marrow failure
lymphadenopathy
splenomegaly
B symptoms

Question 20

what is the staging for CLL called?

Answer 20

binet

Question 21

do CLL usually have mild or severe disease?

Answer 21

stage A - mild

Question 22

what is the management for most people with CLL?

Answer 22

wait and watch

- most people won’t die form the disease

Question 23

what is the treatment for CLL?

Answer 23

cytotoxic chemo
monoclonal antibodies
targeted agents

Question 24

state some indications for CLL treatment ?

Answer 24

progressive bone marrow failure
massive lymphadenopathy
lymphocyte count increasing substantially
autoimmune cytopenias

Question 25

what are some poor prognostic markers?

Answer 25

``` advanced disease atypical lymphocyte morphology CD 38+ expression loss/mutation of p53 rapid lymphocyte doubling time ```

Question 26

is hodgkins disease a specific disease?

Answer 26

yes

Question 27

what gender is most affected by hodgkins disease?

Answer 27

males

Question 28

what ages are most affected by hodgkins disease?

Answer 28

1st peak = 15-35yrs | 2nd peak in later life

Question 29

what is the second peak of hodgkins disease associated with?

Answer 29

epstein barr virus

Question 30

state the presentation of hogkins disease?

Answer 30

lymphadenopathy extra nodal disease B symptoms bone marrow involvement

Question 31

what investigations should be done for hodgkins disease?

Answer 31

lymph node biopsy | bone marrow aspirate

Question 32

what are the four stages of hodgkins disease?

Answer 32

♣ 1 = one location above or below diaphragm ♣ 2 = two locations above or below diaphragm ♣ 3 = above and below diaphragm ♣ 4 = bone involvement and above and below diaphragm

Question 33

what is the treatment for hodgkins disease?

Answer 33

``` combination chemo (ABVD) +/- radiotherapy ```

Question 34

what are three ways non hodgkins disease can be classified ?

Answer 34

lineage grades histological features

Question 35

what lineage of non hodgkins is more common?

Answer 35

B cells

Question 36

is high grade non hodgkins disease curable ?

Answer 36

yes

Question 37

is low grade non hodgkins disease curable ?

Answer 37

no

Question 38

what is high grade non hodgkins treated with?

Answer 38

combination chemo

Question 39

what are the two histologic types of non hodgkins lymphoma?

Answer 39

diffuse large B cell lymphoma | follicular lymphoma

Question 40

what is the commonest types of histological types of non hodgkins?

Answer 40

diffuse B cell lymphoma

Question 41

is diffuse large B cell lymphoma low or high grade?

Answer 41

high

Question 42

is follicular lymphoma low or high grade?

Answer 42

low

Question 43

what is the difference between lymphoma and leukaemia ?

Answer 43

bone marrow involvement in leukaemia