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*Haematology + Immunology > Lymphoid Malignancy > Flashcards

Lymphoid Malignancy Flashcards

1
Q

How are blood/lymphatic cancers defined?

A

Malignant cell characteristics

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2
Q

How are lymphoma/leukaemia diagnosed?

A

Biopsy

Clinical examination/imaging for staging

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3
Q

What are the main lymphoproliferative disorders?

A

Acute lymphoblastic leukaemia (ALL)
Chronic lymphocytic leukaemia (CLL)
Hodgkins and Non-Hodgkins lymphoma

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4
Q

How are non-hodgkins lymphomas differentiated?

A 
High grade (diffuse large B-cell lymphoma)
Low grade (Follicular, marginal zone)
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5
Q

What is Acute Lymphoblastic Leukaemia?

A

Cancerous disorder of Lymphoid progenitor cells

mostly bone marrow, could be anywhere

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6
Q

Acute Lymphoblastic Leukaemia is more common in which groups?

A

Younger male (<6 likely)
1-2/100,000 per year
Down’s Syndrome++

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7
Q

How does Acute Lymphoblastic Leukaemia present?

A 
Recent History of bone marrow failure or bone/joint pain++
Impaired vision
Weight loss
Infection
Sweats
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8
Q

How does Acute Lymphoblastic Leukaemia present on investigation?

A

FBC: Anaemia, elevated WCC, low platelets
Bone marrow: Increased B-lymphoblasts
Histology: Large cells, Express CD19 (+CD34, TDT), Loss of fat space

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9
Q

How is Acute Lymphoblastic Leukaemia treated?

A

Chemotherapy to induce remission, CNS therapy

Stem cell treatment if high risk
Bi-specific T-cell engagers
Chimeric Antigen Receptor (CAR) T-cells

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10
Q

What side effects are associated with T-cell immunotherapy?

A

Cytokine release syndrome (fever, hypotension, dyspnoea)

Neurotoxicity (seizures, coma)

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11
Q

What are the poor prognostic factors for Acute Lymphoblastic Leukaemia?

A

Increasing age
Increased WCC
Genetics (philadelphia chromosome)
Poor response to therapy

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12
Q

How is Chronic Lymphocytic leukaemia diagnosed?

A

Lymphocytes >5
Mature abnormal cells
Low grade markers

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13
Q

How does Chronic Lymphocytic leukaemia present?

A 
Asymptomatic
Bone marrow failure (Anaemia, thrombocytopenia)
Lymphadenopathy
Splenomegaly
Fever and sweats
Immune paresis
Haemolytic anaemia
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14
Q

What findings are often associated with CLL?

A 
Immune paresis (loss of normal immunoglobulin production)
Haemolytic anaemia
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15
Q

How is CLL staged?

A

Binet Staging
A < 3 lymph node areas
B 3 or more
C 3 or more + anaemia or thrombocytopaenia

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16
Q

What median survival is associated with each grade of CLL?

A

A ~
B - 8 years
C - 6 years

17
Q

What are the indications for treatment in CLL?

A

Progressive bone marrow failure
Massive lymphadenopathy
Progressive splenomegaly
Systemic symptoms

18
Q

What is the treatment for CLL?

A

“watch and wait”
Cytotoxic chemotherapy
Monoclobal antibodies
TKIs

19
Q

What are the poor prognostic factors for CLL?

A 
Advanced disease (stage B, C)
Atypical lymphocyte morphology 
Rapid lymphocyte doubling time
p53 loss, del 11q23
CD38+ expression
20
Q

How do lymphomas typically present?

A 
Lymphadenopathy
Hepatosplenomegaly 
Extranodal disease 
Bone marrow involvement
Fever
Night sweats
Weight loss
21
Q

How is Lymphoma investigated?

A

Lymph node biopsy
CT scan
Bone marrow aspirate and trephine

22
Q

How is Lymphoma staged?

A 
Stage 1: 1 node group on 1 side of diaphragm
2: 2 node groups same side of diaphragm
3: Node groups either sides of diaphragm
4: Extranodal metastases 
A: absence of B symptoms
B: Fever, night sweats, weight loss
23
Q

Lymphomas typically affect what?

A

B and T lymphocytes

24
Q

How are non-hodgkin lymphomas classified?

A

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

High vs Low grade

25
Q

How do high vs low grade non-Hodgkin lymphomas differ?

A

Low grade - asymptomatic, responds to chemo but incurable

High grade - aggressive, combination therapy, curable

26
Q

What are the commonest types of Non-Hodgkin Lymphoma?

A 
Diffuse Large B-cell lymphoma (high grade)
Follicular lymphoma (low grade)
27
Q

How are the common non-hodgkin lymphomas treated?

A

(follicular watch and wait first)
Combination chemotherapy
Anti-CD20 monoclonal antibody

28
Q

Hodgkin lymphoma is associated with what?

A

M:F 2:1
15-35y
Epstein-Barr virus
Familial/geographical

29
Q

How is Hodgkin lymphoma treated?

A 
Combination therapy 
Radiotherapy 
Monoclonal antibodies (anti-CD30)
Immunotherapy 
PET scanning
30
Q

How is Hodgkin lymphoma monitored?

A

PET scanning

31
Q

ALL is specifically a disease of what?

A

Bone marrow B-lymphocytes (primarily)

32
Q

Why are the majority of lymphomas B-cell type?

A

Issue arises in the germinal centre as the B-cell matures

*Haematology + Immunology (22 decks)

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