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Haematology > Lymphoid Malignancy > Flashcards

Lymphoid Malignancy Flashcards

1
Q

What is a Lymphoid malignancy

A
  • Cancer of lymphoid origin
  • Can present with lympadenopathy
  • Can present with extranodal involvement
  • Can present with bone marrow involvement
  • Sytemic symptoms (weight loss 10% in 6 months, fever, night sweats, pruritis, fatigue)
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2
Q

How to determine where and what kind of lymphoma it is

A
  • Where = Imaging e.g. CT

- What = Biopsy e.g. lymph node, bone marrow

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3
Q

Difference between lymphoma and leukaemia

A

Leukaemia has bone marrow involvement

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4
Q

What is hodgkin lymphoma and non-hoghkin lymphoma

A
  • Hogdkin = specific disease

- Non-hodgkin = broad term (~50)

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5
Q

4 types of lymphoproliferative disorders

A
  • Acute lymphoblastic leukaemia (ALL)
  • Chronic lymphocytic leukaemia (CLL)
  • Hodgkin lymphoma
  • Non-Hodgkin lymphoma (NHL)(High and low grade)
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6
Q

What cells are involved in low and high grade NHL

A
  • High = Diffuse large B-cell lymphoma

- Low = Follicular, marginal zone

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7
Q

How is acute lymphoblastic leukaemia diagnosed

A

> 20% lymphoblasts present in bone marrow

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8
Q

How does acute lymphoblastic leukaemia present

A
  • 2-3 wk Hx of bone marrow failure +/- raised white cell count
  • Bone/joint pain
  • Infections
  • Sweats
  • ?weight loss?
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9
Q

Rx of acute lymphoblastic leukaemia

A
  • Induction chem to obtain remission
  • Consolidation therapy
  • CNS directed Rx
  • Maintenacne Rx for 10mths

Stem cell transplant (if high risk)

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10
Q

Indications of a poor outcome in acute lymphoblastic leukaemia

A
  • Increasing age
  • Increased white cell count
  • Slow/poor response to Rx
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11
Q

How is Chronic lymphocytic leukaemia diagnosed

A
  • Bone marrow >30% lymphocytes

- Blood >5 x 10 to the 9 lymphocytes

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12
Q

Presentation of chronic lymphocytic leukaemia

A 
-Oftern asymptomatic 
Frequent findings
-Bone marrow failure (anaemia, thrombocytopenia)
-Lymphadenopathy 
-Splenomegaly 
-Fever + sweats

Less common findings

  • Hepatomegaly
  • Infections
  • Weight loss
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13
Q

Chronic lymphocytic leukaemia associated findings

A
  • Immune paresis (loss of normal immunoglobin production)

- Haemolytic anaemia

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14
Q

How is chronic lymphocytic leukaemia staged

A
  • Binet staging

- Stage A, B, C

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15
Q

Describe stage A chronic lymphocytic leukaemia

A
  • <3 lymph node areas

- Median survical = same as age matched controls

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16
Q

Describe stage B chronic lymphocytic leukaemia

A
  • 3 or more lymph node areas

- Median survival = ~8 years

17
Q

Describe stage C chronic lymphocytic leukaemia

A
  • Stage B + anaemia or thrombocytopenia

- Median survival =~6 years

18
Q

Indications for Rx of chronic lymphocytic leukaemia

A
  • Progressive bone marrow failure
  • Massive lymphadenopathy
  • Progressive splenomegaly
  • Systemic cytopenia
19
Q

Rx chronic lymphocytic leukaemia

A
  • Often nothing (“watch and wait”)
  • Cytotoxic chemotherapy e.g. fludarabine, bendamustine
  • Monoclonal antibodies e.g. Rituximab
20
Q

Poor prognostic indicators chronic lymphocytic leukaemia

A
  • Advanced disease (stage B/C)
  • Atypical lymphocyte morphology
  • Rapid lymphocyte doubling time
21
Q

Presentation of lymphoma

A
  • Lymphadenopathy/hepatoslpnomegaly
  • Extranodal disease
  • “B symptoms”
  • Bone marrow involvement
22
Q

Assessment (“staging”) of lymphoma

A
  • Lymph node biopsy
  • CT scan
  • Bone marrow aspirate and trephine
23
Q

How do you classify non-hodgkin lymphoma

A
  • Lineage (B/T-cell)(majority are B-cell in origin)
  • Grade of disease (high or low grade)
  • Histological features of disease
24
Q

Describe low-grade lymphoma

A
  • Indolent, often asymptomatic
  • Responds to chemo but incurable
  • Median survival varies by sub-type
25
Q

Describe high-grade lymphoma

A
  • Aggressive, fast growing
  • Require combination chemotherapy
  • Can be cured, but again varies widely
26
Q

2 specific disease entities of NHL

A
  • Diffuse large B-cell lymphoma (commonest, high grade)

- Follicular lymphoma (2nd commonest, low grade)

27
Q

Rx of diffuse B-cell lymphoma and follicular lymphoma

A

-Combination chemo (anti-CD20 monoclonal antibody + chemo)

28
Q

What is HL associated with

A
  • EBV

- Familial + geographical clustering

29
Q

Rx of hodgkin lymphoma

A
  • Combination therapy
  • +/- Radiotherapy
  • Use of PET to assess response to Rx + to limit use of radiotherapy

Haematology (24 decks)

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