Lymphoid Malignancy Flashcards
What is a Lymphoid malignancy
- 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)
How to determine where and what kind of lymphoma it is
- Where = Imaging e.g. CT
- What = Biopsy e.g. lymph node, bone marrow
Difference between lymphoma and leukaemia
Leukaemia has bone marrow involvement
What is hodgkin lymphoma and non-hoghkin lymphoma
- Hogdkin = specific disease
- Non-hodgkin = broad term (~50)
4 types of lymphoproliferative disorders
- Acute lymphoblastic leukaemia (ALL)
- Chronic lymphocytic leukaemia (CLL)
- Hodgkin lymphoma
- Non-Hodgkin lymphoma (NHL)(High and low grade)
What cells are involved in low and high grade NHL
- High = Diffuse large B-cell lymphoma
- Low = Follicular, marginal zone
How is acute lymphoblastic leukaemia diagnosed
> 20% lymphoblasts present in bone marrow
How does acute lymphoblastic leukaemia present
- 2-3 wk Hx of bone marrow failure +/- raised white cell count
- Bone/joint pain
- Infections
- Sweats
- ?weight loss?
Rx of acute lymphoblastic leukaemia
- Induction chem to obtain remission
- Consolidation therapy
- CNS directed Rx
- Maintenacne Rx for 10mths
Stem cell transplant (if high risk)
Indications of a poor outcome in acute lymphoblastic leukaemia
- Increasing age
- Increased white cell count
- Slow/poor response to Rx
How is Chronic lymphocytic leukaemia diagnosed
- Bone marrow >30% lymphocytes
- Blood >5 x 10 to the 9 lymphocytes
Presentation of chronic lymphocytic leukaemia
-Oftern asymptomatic Frequent findings -Bone marrow failure (anaemia, thrombocytopenia) -Lymphadenopathy -Splenomegaly -Fever + sweats
Less common findings
- Hepatomegaly
- Infections
- Weight loss
Chronic lymphocytic leukaemia associated findings
- Immune paresis (loss of normal immunoglobin production)
- Haemolytic anaemia
How is chronic lymphocytic leukaemia staged
- Binet staging
- Stage A, B, C
Describe stage A chronic lymphocytic leukaemia
- <3 lymph node areas
- Median survical = same as age matched controls
Describe stage B chronic lymphocytic leukaemia
- 3 or more lymph node areas
- Median survival = ~8 years
Describe stage C chronic lymphocytic leukaemia
- Stage B + anaemia or thrombocytopenia
- Median survival =~6 years
Indications for Rx of chronic lymphocytic leukaemia
- Progressive bone marrow failure
- Massive lymphadenopathy
- Progressive splenomegaly
- Systemic cytopenia
Rx chronic lymphocytic leukaemia
- Often nothing (“watch and wait”)
- Cytotoxic chemotherapy e.g. fludarabine, bendamustine
- Monoclonal antibodies e.g. Rituximab
Poor prognostic indicators chronic lymphocytic leukaemia
- Advanced disease (stage B/C)
- Atypical lymphocyte morphology
- Rapid lymphocyte doubling time
Presentation of lymphoma
- Lymphadenopathy/hepatoslpnomegaly
- Extranodal disease
- “B symptoms”
- Bone marrow involvement
Assessment (“staging”) of lymphoma
- Lymph node biopsy
- CT scan
- Bone marrow aspirate and trephine
How do you classify non-hodgkin lymphoma
- Lineage (B/T-cell)(majority are B-cell in origin)
- Grade of disease (high or low grade)
- Histological features of disease
Describe low-grade lymphoma
- Indolent, often asymptomatic
- Responds to chemo but incurable
- Median survival varies by sub-type
Describe high-grade lymphoma
- Aggressive, fast growing
- Require combination chemotherapy
- Can be cured, but again varies widely
2 specific disease entities of NHL
- Diffuse large B-cell lymphoma (commonest, high grade)
- Follicular lymphoma (2nd commonest, low grade)
Rx of diffuse B-cell lymphoma and follicular lymphoma
-Combination chemo (anti-CD20 monoclonal antibody + chemo)
What is HL associated with
- EBV
- Familial + geographical clustering
Rx of hodgkin lymphoma
- Combination therapy
- +/- Radiotherapy
- Use of PET to assess response to Rx + to limit use of radiotherapy
