Lymphoma 2 Flashcards
Why do we
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
Hogkin Lymphoma
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
Staging of Hodgkin’s lymphoma - how is it done?
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
what is one of the worst complications of cHL?
death by compression of the SVC or trachea
What is special about cHL?
it is one of the first lymphomas that were cured by cancer
Chemotherapy
ABVD
Adriamycin
Bleomyin
Vinblastine
DTIC
Given at 4 weekly intervals
Actually preserves fertility, unlike previous treatment regiment of MOPP
Chemotherapy for cHL?
ABVD
Adriamycin
Bleomyin
Vinblastine
DTIC
Given at 4 weekly intervals
Actually preserves fertility, unlike previous treatment regiment of MOPP
When would you use radiotherapy for cHL?
If there is relapse, what do you do?
consolidate chemotherapy and radiotherapy but radiotherapy is only to that particular region.
What is the problem with radiotherapy for cHL?
Lymphoma chance may decrease but other cancers may develop e.g. 1/4 chance of getting breast cancer 25 years later
Name some very aggressive NHLs
Burkitt’s lymphoma
T or B cell lymphoblastic leukemia
Name some aggressive NHLs
Diffuse large B cell lymphoma
Mantle cell lymphoma
Name some indolent NHLs
Follicular
????
Explain the relationship between survival, chemotherapy and the aggressiveness of NHLs.
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.
Name some indolent NHLs
Follicular
small lymphocytic/CLL
mucosa associated MALT
Diffuse large B cell NHL
Age
Stage - ann arbor
LDH - marker of how rapidly the cell is turnign over
ECOG performance status (can they tolerate chmo)
DLBCL treatment regime
6 cycles of rituximab-CHOP
Follicular lymphoma (most common indolent NHL)
35 percent of NHLs
associated with 14;18
overexpression of antiapoptosis bcl2 protein
FLIPI score
Median survival - 12-15 years incurable
Treatment of follicular NHL
You only treat if there is clinical indication as aggressive treatment will worsen it?
??? like what?
Extranodal marginal zone lymphoas e.g. MALT presentaiton
Gastritis
Epigastric pain
ulceration
bleeding
Treat with omeprazole and antibiotics for h pylori
if the antigen stimulation is taken away, the lymphoma will resolve
Enteropathy associated T cell lymphoma
Really awful disease
T cell NHL
Coeliac disease
CLL
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)
Targetted CLL treatment
BCR kinase inhibitors
Ibrutinib (BTK)
Idelalisib (Pi3K)
BCL2??
Prognosis with CLL
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
Targetted CLL treatment
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
