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Haematology (E) > Lymphoma 2 > Flashcards

Lymphoma 2 Flashcards

1
Q

What is the presentation of lymphoma?

A 
Painless progressive lymphadenopathy
Infiltrate/impair an organ system
Recurrent infections
Constitutional symptoms
Coincidental
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2
Q

How may painless lymphadenopathy be detected?

A

Palpable node

Extrinsic compression of any ‘tube’ e.g. ureter, bile duct, large blood vessel, bowel, trachea, oesophagus

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3
Q

What are the diagnosis and staging steps of lymphoma?

A 
Histological diagnosis
Anatomical stage (scans)
Blood tests (baseline, give effect of lymphoma on the patient)
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4
Q

What is the key malignant cell in Hodgkin Lymphoma?

A

Reed Sternberg cells

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5
Q

What are the more common patient characteristics of Hodgkin lymphoma?

A

Bimodal age incidence - age 20-29, smaller peak affecting >60
More common in males

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6
Q

What are the subcategories of classical Hodgkin Lymphoma?

A

Nodular sclerosing
Mixed cellularity
Lymphocyte rich/depleted (rare)

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7
Q

What is stage I for HL?

A

One group of nodes

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8
Q

What is stage II for HL?

A

> 1 group of nodes same side of diaphragm

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9
Q

What is stage III for HL?

A

Nodes above and below the diaphragm

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10
Q

What is stage IV for HL?

A

Extranodal spread

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11
Q

What does suffix A/B mean in HL staging?

A

A is none, B is any of
Fever
Unexplained weight-loss
Night sweats

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12
Q

What are the characteristics of sclerosing subtype of HL?

A

Young women (>men) 20-29yrs
Neck nodes and mediastinal mass
May have B symptoms
Needs a tissue diagnosis

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13
Q

What is the treatment of HL?

A

Chemotherapy
ABVD 2-6 cycles
+/- radiotherapy

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14
Q

What is the role of radiotherapy in HL?

A

Results in low/negligible risk of relapse within field

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15
Q

What is Non-Hodgkin Lymphoma?

A

Neoplastic proliferation of lymphoid cells

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16
Q

What are the steps of management of Non Hodgkin Lymphoma?

A

Stage disease
Prognostic markers
Plant therapy

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17
Q

How is NHL staged?

A

CT scan
PET scan (indicated in aggressive lymphomas)
BM biopsy
Lumbar puncture (if risk of CNS involvement

18
Q

What are the two most common types of non Hodgkin Lymphoma?

A

Follicular lymphoma

Diffuse large B cell lymphoma

19
Q

What is the clinical behaviour of Burkitt Lymphoma and T or B cell lymphoblastic leukaemia/lymphoma

A

Very aggressive

20
Q

What is the clinical behaviour of Diffuse large B cell and mantle cell lymphoma?

A

Aggressive

21
Q

What is the clinical behaviour of follicular, small lymphocytic/CLL and mucosa associated (MALT)?

A

Indolent

22
Q

What is the prognosis of Diffuse Large B cell NHL determined by?

A 
IPI (International Prognostic Index)
Age
Stage (Ann Arbor)
LDH
Extra-nodal disease sites
ECOG performance status
23
Q

What is the genetic association of follicular NHL?

A

t(14;18) which results in over expression of bcl2 an anti-apoptosis protein

24
Q

What is the median survival of follicular NHL?

A

12-15yrs

25
Q

What are the management options for follicular lymphoma?

A

Watch and wait

Treatment

26
Q

What would be indications for treatment while watching and waiting follicular NHL?

A

Nodal extrinsic compression: bowel, Bile duct, ureter, vena cava
Massive painful nodes
Recurrent infections

27
Q

What is the treatment for follicular NHL?

A

Combination immuno-chemotherapy

28
Q

What is MZL?

A

Marginal Zone Lymphoma involving extra-nodal lymphoid tissue (e.g. Gastric mucosa-associated lymphoid tissue MALT/H. Pylori, Parotic MZL/Sjogren syndrome)

29
Q

What is enteropathy associated T cell lymphoma (EATL)?

A

T cell NHL seen in patients with Coeliac disease

Has an aggressive clinical course

30
Q

What is the presentation and clinical course of EATL?

A

Abdominal pain, obstruction perforation, GI bleeding
Malabsorption
Systemic symptoms
Responds poorly to chemo, generally fatal
Aim to prevent (strict adherence to Gluten Free diet)

31
Q

What is chronic lymphocytic leukaemia?

A

Proliferation of mature B-lymphocytes

32
Q

What are the laboratory findings in CLL?

A 
Lymphocytosis between 5 and 300 x 10^9/l
Smear cells
Normocytic normochromic anaemia
Thrombocytopenia
Bone marrow lymphocytic replacement of normal marrow elements
33
Q

What are the different progressions of CLL?

A

Never progress
Progress but respond to treatment
Progress, require multiple lines of treatment –> death

34
Q

What is a genetic indicator of poor prognosis in CLL?

A

Deletion of 17p

35
Q

What are the clinical issues in CLL?

A

Increased risk of infection
Bone marrow failure
Lymphadenopathy +/- splenomegaly, lymphocytosis
Transform to high grade lymphoma (Richter Transformation)
Auto-immune complications

36
Q

What are the indications to treat CLL?

A 
Progressive lymphocytosis
Progressive marrow failure
Massive or progressive lymphadenopathy / splenomegaly
Systemic symptoms
Autoimmune cytopenias
37
Q

What are the treatment options for CLL?

A 
Combination Immuno-chemotherapy
Targeted therapy (BTK inhibitor, BCL2 inhibitor)
Cellular therapy for relapsed high risk cases
38
Q

Give an example of BCR Kinase inhibitors

A

Ibrutinib (BTK)

Idelalisib (PI3K)

39
Q

Give an example of BCL2 inhibitors

A

Venetoclax

40
Q

Give an example of experimental Cell based therapies

A

Chimaeric Antigen Receptor T cells (CAR-T)

Haematology (E) (14 decks)

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