Lymphoid Malignancy Flashcards
1
Q
What is the presentation of lymphoma?
A
- Lymphadenopathy
- +/- extranodal or bone marrow involvement
- B symptoms: weight loss, fever, night sweats, pruritis and fatigue
2
Q
How can a lymphoma or leukaemia be diagnosed?
A
- Biopsy (lymph node, bone marrow etc.) - tells us what type it is
- Examination and imaging give the staging
3
Q
Name the commonest lymphoid malignancies
A
- High grade NHL
- Low grade lymphomas
- Hodgkin lymphoma
- CLL
- ALL
4
Q
How does acute lymphoblastic leukaemia present?
A
- 2/3 week history of bone marrow failure or bone/joint pain
- Weight loss
- can be SOB or have impaired vision
- Infection and night sweats
5
Q
What investigations should be done for ALL?
A
- FBC: low haemoglobin, raised WCC and low platelets
- Bone marrow biopsy
6
Q
Describe the characteristics of ALL cells
A
- Large cells
- Express CD19 (all B cells have this)
- CD34 and TDT: markers of very early immature cells
7
Q
How can ALL be treated?
A
- Induction chemotherapy
- Consolidation therapy
- CNS directed treatment
- Maintenance treatment for 18 months
- Stem cell transplantation (if high risk)
- New therapies: Bi-specific T cell engagers and CAR)
8
Q
What are the side effects of T cell immunotherapy?
A
- Cytokine release syndrome: fever, hypotension and dyspnoea
- CAR T cell - significant number require ICU support
- Neurotoxicity: confusion, normal conscious level, seizure, headache, focal neurology and coma
9
Q
What are the poor risk factors for ALL?
A
- Increasing age
- Increased white cell count
- Cytogenetics/molecular genetics: t(9;22) an t(4;11)
- Slow/poor response to treatment
10
Q
How does CLL present?
A
- Bone marrow failure (anaemia and thrombocytopenia)
- Lymphadenopathy
- Splenomegaly
- Fever and sweats
11
Q
What can be associated with CLL?
A
- Immune paresis
- Haemolytic anaemia
12
Q
What is the staging system for CLL?
A
Binet:
- A: <3 lymph node areas
- B: 3 or more lymph node areas
- C: stage B + anaemia or thrombocytopenia
13
Q
What are the indications for treatment in CLL?
A
- Progressive bone marrow failure
- Massive lymphadenopathy
- Progressive splenomegaly
- Lymphocyte doubling time < 6 months
- Systemic symptoms
- Autoimmune cytopenia
14
Q
What are the treatment options for CLL?
A
- Often watch and wait
- Cytotoxic chemotherapy
- Monoclonal antibodies
- Novel agents: Bruton tyrosine kinase inhibitor, PI3K inhibitor and BCL-2 inhibitor
15
Q
What are the poor prognostic factors for CLL?
A
- Advanced disease (stage B or C)
- Atypical lymphocyte morphology
- Rapid lymphocyte doubling time
- CD38+ expression
- Loss/mutation of p53 or deletion of 11q23
- Unmutated IgVH gene status
