Lymphoma 2

Question 1

Why do we

Answer 1

There can be a fatal reactivation of hep B if we wipe out B-cells, therefore we need to make sure we know their hep b serology

Question 2

Hogkin Lymphoma

Answer 2

Bimodal peak - more common in young women, present with nodular sclerosis subtype on histology (thick bands of fibrous tissue around reed sternberg’s cells)

Smaller peak affecting elderly over 60 years old

B symptoms - fever
night sweats
weight loss

if present, A, if not present, B

Question 3

Staging of Hodgkin’s lymphoma - how is it done?

Answer 3

FDG-PET/CT scan to examine lymph nodes.

Hodgkin’s lymphoma only spreads via lymph nodes initially.

if a single group of nodes are enlarged, that’s stage 1
more than 1 group of nodes on one side of the diaphragm

if there are nodes either side of diaphragm - stage 3
if there is EXTRAnodal spread beyond the lymphatic system, it’s stage 4

Question 4

what is one of the worst complications of cHL?

Answer 4

death by compression of the SVC or trachea

Question 5

What is special about cHL?

Answer 5

it is one of the first lymphomas that were cured by cancer

Question 6

Chemotherapy

Answer 6

ABVD

Adriamycin
Bleomyin
Vinblastine
DTIC

Given at 4 weekly intervals

Actually preserves fertility, unlike previous treatment regiment of MOPP

Question 7

Chemotherapy for cHL?

Answer 7

ABVD

Adriamycin
Bleomyin
Vinblastine
DTIC

Given at 4 weekly intervals

Actually preserves fertility, unlike previous treatment regiment of MOPP

Question 8

When would you use radiotherapy for cHL?

Answer 8

If there is relapse, what do you do?

consolidate chemotherapy and radiotherapy but radiotherapy is only to that particular region.

Question 9

What is the problem with radiotherapy for cHL?

Answer 9

Lymphoma chance may decrease but other cancers may develop e.g. 1/4 chance of getting breast cancer 25 years later

Question 10

Name some very aggressive NHLs

Answer 10

Burkitt’s lymphoma
T or B cell lymphoblastic leukemia

Question 11

Name some aggressive NHLs

Answer 11

Diffuse large B cell lymphoma
Mantle cell lymphoma

Question 12

Name some indolent NHLs

Answer 12

Follicular
????

Question 13

Explain the relationship between survival, chemotherapy and the aggressiveness of NHLs.

Answer 13

Median survival without treatment is better with indolent NHLs, however response to chemo actually goes down with indolent NHLs and is much better in very aggressive NHLs.

Question 14

Name some indolent NHLs

Answer 14

Follicular
small lymphocytic/CLL
mucosa associated MALT

Question 15

Diffuse large B cell NHL

Answer 15

Age
Stage - ann arbor
LDH - marker of how rapidly the cell is turnign over

ECOG performance status (can they tolerate chmo)

Question 16

DLBCL treatment regime

Answer 16

6 cycles of rituximab-CHOP

Question 17

Follicular lymphoma (most common indolent NHL)

Answer 17

35 percent of NHLs

associated with 14;18

overexpression of antiapoptosis bcl2 protein

FLIPI score

Median survival - 12-15 years incurable

Question 18

Treatment of follicular NHL

Answer 18

You only treat if there is clinical indication as aggressive treatment will worsen it?

??? like what?

Question 19

Extranodal marginal zone lymphoas e.g. MALT presentaiton

Answer 19

Gastritis
Epigastric pain
ulceration
bleeding

Treat with omeprazole and antibiotics for h pylori

if the antigen stimulation is taken away, the lymphoma will resolve

Question 20

Enteropathy associated T cell lymphoma

Answer 20

Really awful disease
T cell NHL
Coeliac disease

Question 21

CLL

Answer 21

Mature B lymphocytes, disorder of the elderly

Smear cells and lymphocytosis with mature lymphocytes

T cells are in peripheral blood are CD5 positive but CD 19 negative

Normal B cells are CD19 positive but CD5 negative

If you have B lymphocytes which has abnormal expression of CD5 (which should normally be on T cells, you’re thinking CLL)

Question 22

Targetted CLL treatment

Answer 22

BCR kinase inhibitors

Ibrutinib (BTK)
Idelalisib (Pi3K)

BCL2??

Question 23

Prognosis with CLL

Answer 23

1/3 progresses
1/3 progress but don’t die from this
1/3 die from CLL

IgHV unmutated plus p53 mutation is BAD

p53 is an important anti-oncogene
loss of chromosome 17p

Question 24

Targetted CLL treatment

Answer 24

BCR kinase inhibitors

Ibrutinib (BTK)
Idelalisib (Pi3K)

BCL2??

venetoclax - anti bcl 2 drug (bcl2 is anti-apoptosis)

they’ve released
potassium
uric acid
and other things

as patients are risk of dying from tumour lysis syndrome