Lymphoma Flashcards
what is lymphoma
clonal neoplastic prolilferation of lymphoid cells- Hodgkin and non hodgkin
what is the % B cell and T cell lymphomas in NHL
85% B cell, 15% T cell
what is present in histology HL
Reed Sternberg cells
which is more common HL or NHL
NHL is 7x more common
most freq NHL B cell cancers
diffuse large B cell, follicular lymphoma
presentation patient
enlargement lymph nodes, systemic symptoms- weight loss, night sweats, local mass.
what are NHL split into
B cell and T cell
examples T cell NHL
T cell prolymphocytic leukaemia; mycosis fungoides; sezary syndrome
examples low grade B cell NHL
small lymphocytic leukaemia, follicular lymphoma, mantle cell, marginal cell
examples high grade B cell NHL
diffuse large B cell, burkitts
what are the types of Burkitts
spontaneous, endemic, immunodeficiency associated
what can patient with sporadic Burkitts present with
abdominal mass
what do patients have with immunodeficiency associated BL
HIV
do less or more aggressive tumours respond better to treatment
more aggressive. low grade tend to relapse
what is the cell origin of hodgkins
B cell
which type of HL has the best prognosis
lymphocyte rich
classifications classic hodgkins
nodular sclerosis, lymphocyte rich, mixed cellularity, lymphocyte depleted
classification HL
nodular lymphocyte predominant HL, Classic HL
what are reed Sternberg cells
multinucleate cells- mirror image nuclei
worst prognosis in classical HL
lymphocyte deplete
features HL
lymphadenopathy- cervical and painless; nodes fluctuate in size; 25% systemic upset- weight lo;ss, sweats, pruritus, lethargy
signs HL
lymph node enlargement. cachexia, anaemia, spleno/hepatomegaly
lab features HL
anaemia (normochromic, normocytic) leucocytosis, raised ESR, abnormal LFTs
diagnosis
biopsy of lymph node. FBC, film, ESR, LFT, LDH, urate, Ca
what indicates a worse prognosis on bloods in HL
incr ESR or decr Hb
what system is used for staging in HL
ann arbor staging
staging of HL
1- single lymph node area; 2- >2 lymph node areas above diaphragm; 3-above and below diaphragm; 4- involvement of other organs- A- no systemic symptoms, B- presence systemic syptoms
what diagnostic tool is used for staging
PET/CT
what treatment for early disease HL- stage 1A or 2A
radiotherapy
what treatment for advanced disease HL- stage 1B,2B,3,4
chemo- combination- 6 cycles ABVD
what does ABVD stand for- chemo
Adriamycin, bleomycin, vinblastine, dacarbzine
if pt relapses following radiotherapy alone in HL what is the prognosis following CCT
very good, >80% complete remission
if HL patient relapses
poor, consider stem cell transplantation
what is the prognosis HL
stage 1-2: >90%; 4: 50-70%
poor prognostic factors for HL
increasing age, male, anaemia, leucocytosis, stage 4, B symptoms, bulky tumour, incr sites disease, early relapse, high ESR, lymphopenia
what happens in NHL
clonal expansion of an abnormal cell
risk factors NHL
EBV- Burkitts; bacterial infection, radiation, drugs, autoimmune disease, immune suppression
clinical features NHL
lymphadenopathy- widely disseminated at presentation, splenomeg, extranodal disease, extranodal disease more common than in HL
lab features NHL
anaemia, pancytopenia, lymphocytosis, paraprotein, LDH raised
diagnosis NHL
tissue biopsy, immunophenotyping to see if B or T cell origin, antigenic markers, CT, MRI, PET, bone marrow aspirate, trephine
how is NHL staged
same as for HL
management- what can be given to patient with follicular lymphoma
rituximab
what can diffuse large B cell be treated with
full course chemo
clinical course follicular lymphoma
indolent for many years, transforms to a more aggressive large cell lymphoma in 1/3
what does splenic marginal cell lymphoma present with
enlarged spleen, AIHA, paraprotein, monoclonal B lymphocytes
where does MALT occur
mucosa associated lymphoid tissue in stomach assoc with H pylori
what is the prognosis of mantle cell
poor- only a few years
what is the most common NHL T cell
peripheral T cell lymphoma
how can aggressive lymphoma be treated
deep x ray therapy (DXT) with adjuvant CCT
difference in treatment for B and T cell tumours
rituximab is not used in T cell
what can be used for indolent tumours NH if they need treatment
single agent chemo or CCT
how is mycosis fungoides treated
skin targeted therapies- PUVA, topical steroids, vit D
what does rituximab do
monoclonal antibody for CD20 protein (antigen), which is found on the surface of B cell.
