lymphoma Flashcards
what is the epidemiology of Chronic Lymhocytic Leukemia (CLL)
dz of older age median age of 72 y.o
what would be the absolute lymphocyte count be in CLL
5,000 mm and these lymphocytes are small B cells
+CD19, 20, 23 (B cell Ags)
as well as being + for the T cell Ag CD5
What would are the signs of CLL
most pts are diagnosed on CBC fatigue and lymphadenopathy Anemia and thrombocytopenia Decreased IgG Nucleus same size as cell
the rai system 0
lymphocytosis and no lyphadenopathy
rai system 1
lymphocytosis and lynphadenoapthy
rai system 2
lymphocytosis and splenomegaly +/- lymphadenopathy
rai system 3
lymphocytosis and anemia d/t CLL
rai system 4
lymphocytosis and thrombocytopenia d/t CLL
CLL tx rai 0 or 1
observation
CLL tx rai 2,3 or 4 and signs of weight loss
FLudarabine, cytoxan
fludarabine
bendamustine
what are the signs of hairy cell leukemia
cytopenias inculding fever, bleeding, fatigue and SOB
Splenomegaly is common
Lymphadenopathy is not
+CD19&20,11c,103
what is the Tx for hairy cell leukemia
purine analogs
Cladribine
Malt and Mucosoal associated lymphoid tissue
most have t(11:18)
fusion of API12:MLT that inhibits apoptosis
cells are CD20+ and CD5 neg
caused by h. pylori d/t chronic Ag stimulation
Follicular lymphomas
2nd MC of adult lymphomas
what are the criteria for FLIPI
age > 60 Increased LDH Ann arbor III or IV Hgb<12 extra nodal dz
Follicular lymphomas characteristics
positive B cell CD 10&20
Tx is reserved for pt with
Burkitts lymphoma is endemic where
sub sahara africa where pt present with Jaw mass
what is the cause if Bukitts lymphoma
EBV infection
What does the CD test positive for
10,19,20
and oncogene c-MYC
how is burkitts tx
high dose chemotherapy
what is sezarys syndrome, mycosis fungoides
most present with an III defined diffuse red rash
circulating tumor cell in this disease called sezary
once the disease forms plaques, nodules or lymphadenopathy its called mycosis fungoides
what is the treatment for sezary’s syndrome
light therapy
psoralens or topical steroids
how does hodgkins lymphoma present
presents with central lymphadenopathy and frequently B symptoms fever weight loss, sweats, +/- puritis
spreads from one adjacent nodal group to the next
Bi modal freq peak age 30 and 70
1/2 are associated with EBV
what does Hodgkins lymphoma look like
Reed sternberg cell
multi-lobed nucleus owl appearance
CD 30+
Reactive cells: polys, macrophages, Eos & fibroblasts
what is the treatment for hodgkins
ABVD
Adriamycin
Bleomycin
Vinblastine and DTIC
what is multiple myeloma
disease of mature functioning B cells which are characterized by the production and over production of Immunoglobulins
what is the immunoglobulin in waldenstroms macroglobulinemia
IgM
what is the immunoglobulin in multiple myeloma
usually IgG but may be IgA or rarely IgD
what is the median age at presentation?
65 yo
2x frequent in african americans as in caucasians
what does the mnemonic CRAB used for
multiple myeloma hyper-Calcemia Renal failure Anemia lytic Bone lesions >10% monoclonal plasma cells in the bone marrow serum monoclonal IgG or IgA >3g/dL
what are symptoms of multiple myeloma
bone pain, particularly back pain
pathological fracture
hypercalcemia
what is the TX of MM
make sure end organ damage is minimized
keep well hydrated
Call hematologist
packed red blood cells for anemia
If candidate for hematopoietic stem cell transplant avoid alkylating agents: Lenalidomide, Dexamethasone, Bortezomib
If not candidate use melphalan, steroids, bortezomib, proteasome
who does waldenstrom macroglobulinemia affect
pt >65 y.o.
cells are positive for CD 19, 20 and surface IgM
what are the main symptoms of waldenstrom macroglobulinemia
hyper viscosity d/t elevated IgM
lethargy, confusion, weakness, anemia
bones lesions absent
peripheral neuropathy
what is the Tx for waldenstrom macroglobulinemia
plasmapharesis
rituximab & cyclophosphamide
