Lymphoid Malignancy Flashcards
What are the different ways that lymphomas can present?
1) Lymphadenopathy
2) Extranodal Involvement
3) Bone Marrow Involvement
4) Systemic B symptoms
What are the systemic (B) symptoms associated with lymphomas?
1 - Weight loss (>10% in 6 months)
2 - Fever
3 - Night sweats
4 - Pruritis
5 - Fatigue
What is the definitive way to define the type of lymphoma?
Biopsy (lymph node or bone marrow)
What information can clinical examination and imaging give us about a lymphoma?
Where it is
What are the 2 broad categories of lymphoma?
1) Hodgkin Lymphoma
2) Non-hodgkin Lymphoma
What is the difference between HL and NHL?
HL - specific disease
NHL: - broad term covering around 50 subtypes of lymphoma
What are the lymphoproliferative disorders?
Acute Lymphoblastic Leukaemia
Chronic Lymphocytic Leukaemia
Hodgkin Lymphoma
Non-hodgkin lymphoma
What are the different types of NHL?
High-grade
Low-grade
What are the characteristics of high-grade NHL?
Diffuse
Large B-cell lymphoma
What are the characteristics of low-grade NHL?
Follicular
Marginal zone
Is HL or NHL more common?
NHL is more common than HL
What is ALL and what are its features?
Acute Lymphoblastic Leukaemia
- Cancer of lymphoblasts
How is ALL diagnosed?
> 20% lymphoblasts present in bone marrow
What is the most common age group affected by ALL?
Children < 6 years old
What is the most common presentation of ALL?
2-3 week history of bone/joint pain
What are the characteristic blood markers of ALL and what is their cause?
All due to bone marrow failure caused by over proliferation of lymphoblasts:
Haemoglobin - Low
WCC - High
Platelets - Low
Apart from joint pain, what other features are commonly seen in ALL?
1 - Impaired vision (retinal haemorrhages)
2 - Weight loss
3 - Infection
4 - Severe night sweats
How is ALL treated?
1 - Chemotherapy cures systemic disease
2 - Stem cell transplantation if high risk
What are some of the newer therapies available for ALL and what is their general mode of action?
1) BiTe molecules
2) CAR
They are both T-cell immunotherapies
What are the common side effects of T-cell immunotherapy?
1) Cytokine release syndrome
2) Neurotoxicity
What are poor prognostic factors for ALL?
1 - Increasing age
2 - Increased WCC
3 - Poor response to treatment
How is CLL diagnosed?
Blood shows > 5x10^9/L lymphocytes
Bone marrow shows > 30% lymphocytes
B-cell markers and CD5 +VE
Are males or females more affected by CLL?
Males 2:1
How does CLL present?
1 - Often asymptomatic at presentation
2 - Bone marrow failure (anaemia + thrombocytopenia)
3 - Lymphadenopathy
4 - Splenomegaly
5 - Fever and sweats
What is the staging system used for CLL?
Binet
What are the different stages of the Binet system and what are their clinical features?
A - < 3 lymph node areas involved
B - 3 or more lymph node areas involved
C - Stage B + anaemia or thrombocytopenia
What are the indications that CLL treatment should be started?
1 - Bone marrow is failing progressively
2 - Massive lymphadenopathy
3 - Progressive splenomegaly
4 - Lymphocyte number doubles in < 6 months
What is the treatment for CLL?
1 - Watch and wait
2 - Cytotoxic chemotherapy
3 - Monoclonal antibodies
What are poor prognostic factors for CLL?
1 - Binet stage B or C
2 - Abnormal lymphocyte morphology
3 - Rapid lymphocyte doubling time (<12 months)
4 - Loss of p53
5 - CD 38+ expression
What is the classic presentation of lymphoma?
1) Lymphadenopathy
2) Extranodal disease
3) B symptoms (weight loss, night sweats, pruritis, fever)
4) Hepatic or Spleno megaly
5) Bone marrow involvement
How are lymphomas assessed and ‘staged’?
1 - Lymph node biopsy
2 - CT scan
3 - Bone marrow aspirate
How are NHL’s classified?
1) According to cell lineage:
T-cell
B-cell
2) Grade of disease (high or low)
3) Histological features
What cell type do most NHL’s originate from?
B-cell
What are the features of a low-grade NHL?
1 - Asymptomatic
2 - Responds to chemo
3 - Slow growing
What are the features of a high-grade NHL?
1 - Aggressive + fast-growing
2 - Requires combination chemo
What are the 2 most common subtypes of NHL and what grade are they?
1) Diffuse large B-cell lymphoma - high grade
2) Follicular lymphoma - low grade
How are NHL’s treated?
Monoclonal antibodies + chemotherapy
What is the age distribution for Hodgkin lymphomas?
Twin peaks:
1 - 15-35 y.o.
2 - Later in life
With which virus is Hodgkin lymphoma commonly associated with?
Epstein-Barr virus
How is Hodgkin Lymphoma treated?
1) Combination chemo
2) Monoclonal antibodies
