Lymphoma Flashcards
What is the broad classification of lymphomas?
Hodgkin v non-Hodgkin
How is Hodgkin lymphoma classified?
Classical v other
How is non-Hodgkin lymphoma classified?
Sub classified according to:
- cell lineage e.g. B v T
- functionally into clinically distinct disease groups based on aggressiveness
When should lymphoma be suspected?
- Palpable pathological lymphadenopathy (firm, rubbery, non-tender)
- Dyspneoa and cough w/ subsequent demonstration of mediastinal mass
- Abdo swelling and/or progressive discomfort (non-specific)
- PUO and night sweats
Ix in ?lymphoma?
- FBE: anaemia (chronic disease), eosinophilia, leukocytosis
- Biochem: HIV, LFTs, UEC, ESR, LDH
- Imaging: CXR, CT CAP
- Excisional LN biopsy + histopath
- Immunohistochemistry
- Radiological staging
- BMA assessment (morphology, immunohistochemistry, flow cytometry)
Microscopic features of lymph node biopsy of classical Hodkgkin lymphoma?
- Nodularity
- Sclerosis
- Reed Sternberg cells
- +/- occasional eosinophils
How is diagnosis of Hodgkin lymphoma confirmed?
- CD30 immunostain showing clear membranous and Golgi apparatus staining of the Reed Sternberg cells
- CD15 +ve
How is lymphoma staged?
Ann Arbor Staging (I-IV) A or B
Critical for Mx decisions.
What is the Ann Arbor staging classification?
I: single region (i.e. one LN and surrounding area)
II: two separate regions, confined to one side of diaphragm
III: lymphoma involves LNs/organs on both sides of diaphragm
IV: diffused/disseminated involvement of extra lymphatic organs
What does the A or B of Ann Arbor staging classification?
A or B: the absence of constitutional (B-type) symptoms (weight loss / fever / night sweats) is denoted by adding an A to the stage; adding B indicates presence of B symptoms.
What are the considerations in determining treatment of lymphoma?
- Prognostic models to determine intensity
- potential impact on fertility in young women
- increased risk of breast malignancy / CAD due to RT exposure
What is the prophylaxis against tumour lysis?
- Hydration
- Monitoring of electrolytes
- Drugs to lower uric acid
How does follicular NHL often present?
- Low grade
- Often presents with painless, slowly growing lymphadenopathy (may wax and wane)
- Usually stag 4 at diagnosis (BM often involved)
Histology of Burkitt lymphoma?
Cells with vacuolated cytoplasm
What is ofatumumab?
Abs against target on B cell: CD22
What is blinatumumab?
Anti CD19 (B cell antigen) combined with a receptor which attracts T cells, causing T cell mediated tumour cell kill.
What is lymphoma?
Collection of lymphoid malignancies in which malignant lymphocytes accumulate at lymph nodes and lymphoid tissues.
What is Hodgkin lymphoma?
Malignant proliferation of lymphoid cells with Reed Sternberg cells (though to arise from germinal centre B cells)
Epidemiology of Hodgkin lymphoma?
- Bimodal distribution with peaks at 20y and >50y
- Ass/w EBV
How does Hodgkin lymphoma classically present?
Painless, non-tender, firm, rubbery enlargement of superficial LNs most often in the cervical region.
CFx of Hodgkin lymphoma?
- Asymptomatic lymphadenopathy (70%)
- Splenomegaly (50%)
- Mediastinal mass (routine CXR, SVC syndroe)
- Systemic symptoms (B Sx)
What are the complications of Hodgkin lymphoma treatment?
- Cardiac disease 2” to RT
- Pulmonary disease 2” to bleomycin
- Infertility
- Secondary malignancy in irradiated field (MDS, AML, solid tumours of lung/breast)
Prognosis of Hodgkin lymphoma?
Hasenclever adverse prognostic factors: 1. serum albumin 45y 6. Leukocytosis 7. Lymphocytopenia Each score decreases freedom from progression at 5y.
What is Non-Hodgkin lymphoma?
Malignant proliferation of lymphoid cells of progenitor or mature B or T cells
What is the WHO classification of NHL?
- INDOLENT: follicular lymphoma, small lymphocytes lymphoma, mantle cell lymphoma
- AGGRESSIVE: diffuse large B cell lymphoma
- HIGHLY AGGRESSIVE: Burkitt’s lymphoma
How does NHL usually present?
- Painless superficial lymphadenopathy
- Cytopenia: when bone marrow involved
- Hepatosplenomegaly
Treatment indolent NHL?
Goal = Sx Mx
- watchful waiting
- RT for localised disease
- CHOP + rituximab (anti CD20) for advanced disease
What is CHOP?
- Cyclophosphamide
- Hydroxydoxorubicin (adriamycin)
- Oncovin (vincristine)
- Prednisone
Treatment of aggressive NHL?
Goal = curative.
- combo chemo: CHOP +/- rituximab
- RT for localised disease
- CNS prophylaxis with high dose methotrexate if certain sites involved (testicular, nasopharyngeal)
How does treatment differ between HL and NHL?
Treatment for HL depends on stage. Treatment for NHL depends on histologic subtype.
Complications of NHL?
- Hypersplenism
- Infection
- AI haemolyti anaemia and thrombocytopenia
- Vascular obstruction (due to enlarged LNs)
- Tumour lysis syndrome
What are the major types of NHL?
- Follicular
- Diffuse large B cell (DLBCL)
- Burkitt lymphoma
- Mantle cell
What is Richter’s transformation?
5% CLL patients progress to DLBCL
