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Haematology > Lymphoid Malignancy > Flashcards

Lymphoid Malignancy Flashcards

1
Q

What are lymphomas?

A

Cancers of lymphoid origin

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2
Q

How do lymphomas present?

A

Enlarged lymph nodes
(Extranodal involvement)
(Bone marrow involvement)
Systemic symptoms

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3
Q

Systemic symptoms associated with lymphoma

A 
Weight loss
Fever
Night sweats
Pruritis
Fatigue
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4
Q

How is a lymphoma/leukaemia diagnosed?

A

Biopsy

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5
Q

How is a lymphoma/leukaemia staged?

A

Clinical examination and imaging - where it is

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6
Q

Which cancer is associated with lymphoid progenitor cells?

A

ALL

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7
Q

Which cancer is associated with B cells and T cells?

A

Lymphomas/CLL

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8
Q

Which cancer is associated with plasma cells?

A

Multiple myeloma

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9
Q

What are the types of lymphoma?

A

Hodgkin lymphoma

Non hodgkin lymphoma

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10
Q

What are the types of non Hodgkin lymphomas?

A

High grade

Low grade

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11
Q

Lymphoproliferative disorders

A

Hodgkin lymphoma
Non-Hodgkin lymphoma
CLL
ALL

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12
Q

What is ALL?

A

Cancerous disorder of lymphoid progenitor cells

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13
Q

What normally happens with lymphoid progenitor cells?

A

Immature, rapidly differentiateinto lymphocytes

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14
Q

What normally happens with lymphoid progenitor cells in leukaemia?

A

No differentiation - instead, rapid, uncontrolled growth and accumulation (usually in bone marrow but they can go anywhere)

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15
Q

How does ALL present?

A

2-3 week history of bone marrow failure or bone/joint pain
Infection
Sweats
+/- raised white cell count

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16
Q

Laboratory results in ALL

A

Decreased Hb
Decreased platelets
Increased white cell count

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17
Q

What is the main cell type involved in ALL?

A

B cell lineage

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18
Q

ALL cell characteristics

A

Large cells
Express CD 19 (contained by all B cells)
CD34, TDTD (markers of early, immature cells)

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19
Q

ALL treatment

A

Chemo for remission
Consolidation therapy
CNS directed treatment
Maintenance treatment for 18 months

Stem cell transplantation if high risk

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20
Q

Newer treatment ALL

A

Bi-specifc T-cell engagers

CAR (chimeric antigen receptor T-cells)

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21
Q

T-cell immunotherapy side effects

A

Cytokine release syndrome

Neurotoxicity

22
Q

Cytokine release syndrome

A

Fever
Hypotension
Dyspnoea

23
Q

Neurotoxicity

A 
Confusion with normal conscious level
Seizure
Headache
Focal neurology
Coma
24
Q

ALL poor prognostic factors

A

Increasing age
Increased white cell count
Slow/poor response to treatment

25
Q

What is the difference between cells in ALL and CLL?

A

Abnormal cells in CLL are very mature - usually resemble normal lymphocytes

26
Q

What lymphocyte count is required for a diagnosis of CLL?

A

> 5 (normal is <4)

27
Q

CLL presentation

A

Often asymptomatic

Bone marrow failure
Lymphadenopathy
Splenomegaly
Fever and sweats

28
Q

CLL associated findings

A

Immune paresis

Haemolytic anaemia

29
Q

Immune paresis

A

Loss of normal immunoglobulin production

30
Q

Binet CLL staging

A

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

31
Q

CLL indications for treatment

A 
Progressive bone marrow failure
Massive lymphadenopathy 
Progressive splenomegaly
Lymphocyte doubling time <6 months or >50% increase over 2 months
Systemic symptoms
Autoimmune cytopenias
32
Q

CLL treatment

A

Often watch and wait

Cytotoxic chemotherapy
Monoclonal antibodies
Novel agents

33
Q

Cytotoxic chemotherapy agents

A

Fludarabine

Bendamustine

34
Q

Monoclonal antibody agents

A

Rituximab

Obinatuzumab

35
Q

Novel agents CLL

A

Bruton tyrosine kinase inhibitor

36
Q

CLL poor prognostic factors

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)
37
Q

Presentation of lymphoma

A

Lymphadenopathy/ hepatosplenomegaly
Extranodal disease
“B symptoms”
Bone marrow involvement

38
Q

How is lymphoma staged?

A

Stage 1-4 => increasing number of sites
A - absence of B symptoms
B - Fever, night sweats, weight loss

39
Q

How is non Hodgkin lymphoma classified?

A

Lineage - B cell or T cell (90% B cell)

Grade - high/low

40
Q

Low grade lymphoma

A

Indolent, often asymptomatic

Responds to chemotherapy but incurable

41
Q

High grade lymphoma

A

Aggressive, fast-growing
Require combination chemotherapy
Can be cured

42
Q

What are the two main types of non Hodgkin lymphoma?

A

Diffuse large B-cell lymphoma

Follicular lymphoma

43
Q

Diffuse large B-cell lymphoma

A

High grade

Commonest subtype of lymphoma (of any kind)

44
Q

Follicular lymphoma

A

Low grade lymphoma

45
Q

What is Hodgkin lymphoma associated with?

A

EBV

Familial and geographical clustering

46
Q

Hodgkin lymphoma treatment

A

Combination chemotherapy +/- radiotherapy

Monoclonal antibodies (anti-CD30)
Immunotherapy (checkpoint inhibitors)
Stem cell transplant
47
Q

Hodgkin lymphoma presentation

A 
Systemic symptoms =>
Night sweats
Unintentional weight loss
Fever
SOB/persistant cough

Swelling in neck, armpit or groin

48
Q

High grade NHL

A

Diffuse large B-cell lymphoma

49
Q

Low grade NHL

A

Follicular, marginal zone

50
Q

Poor cancer prognosis factor

A

loss/mutation of p53

51
Q

What is p53?

A

Tumour suppression gene

52
Q

Lymphoma staging

A

A - absence of B symptoms
B - fever, night sweats, weight loss

Stage 1 - 1 node
Stage 2 - more than one node but on the same side of the diaphragm
Stage 3 - no extranodal involvement but both sides of the diaphragm
Stage 4 - extranodal involvement

Haematology (18 decks)

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