Lymphoma Flashcards
What percentage of lymphoma is Hodgkins, and Non-Hodgkins?
Hodgkins = 20% Non-Hodgkins = 80%
Clinical Presentation of Hodgkins Lymphoma
Assymetrical painless lymphadenopathy +/- obstructive/mass effect symptoms +/- constitutional symptoms (weight loss, fever, night sweats, pruritis, fatigue.
Pel-Ebstein Fever seen in minority. Can rarely get pain in affected nodes after alcohol.
Epidemiology of Hodgkins Lymphoma
M>F; bimodal age incidence (20-29 and >60)
EBV associated
Investigations for Hodgkins Lymphoma, how is it diagnosed?
CT/PET
Tissue Diagnosis: LN or BM biopsy - cell stain with CD15 & CD30 –> Reed-Sternberg cell on a background of lymphocytes and reactive cells
Definitive diagnosis = LN biopsy, Staged using PET/CT
What are the characteristics of a Reed Sternberg Cell?
In what percentage of cases are the RS cells found to be infected with EBV?
large size (20–50 micrometres), abundant, amphophilic, finely granular/homogeneous cytoplasm; two mirror-image nuclei (owl eyes) each with an eosinophilic nucleolus and a thick nuclear membrane. 50% of cases cells are infected with EBV
What are the subtypes of HL? What is the most common subtype and what are the prognoses for each?
Nodular sclerosing - most common, 80%, good prog.
Mixed cellularity - 17%, good prog
Lymphocyte Rich - rare, good prog
Lymphocyte depleted - rare, poor prog
Nodular Lymphocyte predominant - not classical HL, 5%, (disorder of the elderly, multiple recurrences)
Stages of Hodgkin’s Lymphoma
Stage 1 - one LN region (can include spleen)
Stage 2 - 2 + LN regions on the same side of the diaphragm
Stage 3 - 2+ LN regions on opposite sides of the diaphragm
Stage 4 - extranodal sites (liver, BM)
A: no constitutional symptoms B: Constitutional symptoms
Treatment for Hodgkins Lymphoma
- Combination Chemotherapy - ABVD: Adriamycin, Bleomycin, Vinblastine and Decarbazine; 2-4 cycles in stage 1/2, 6-8 cycle in stage 3/4
- Radiotherapy - used at end of chemo in bulky areas
- Intensive chemo and autologous SCT - for relapsed patients
Prognosis of Hodgkins Lymphoma
Generally v. good: 50-90% cured
50% for stage 4
Worse prog. in older patients and patients with lymphocyte depleted histology.
Describe the process of Autologous SCT, its advantages and when it is used.
Autologous = patients own SCs are harvested and frozen.
Enables high dose chemo +/- radiotherapy to eradicate malignant cells at the cost of partial or even complete bone marrow ablation. Frozen SCs are then reintroduced into patient.
Used: multiple myeloma and lymphoma, particularly with relapse, less used in leukaemia
Advantages: no graft host disease (GVHD) risk and lower risk of infection
Describe the process of Allogenic SCT, its risks and when it is used.
Allogenic = HLA-matched donor SCs are harvested
Patients own BM is completely eradicated by high-does chemo +/- radiotherapy. Donor Scs are introduced to colonise ‘empty’ BM
Used: Leukaemia
Risks: GVHD, opportunistic infections, infertility and secondary malignancies
How is Non-Hodgkins Lymphoma staged (investigation and classification system)?
Name 2 prognostic markers in NHL.
Ix: CT/PET, BM biopsy, LP
Classification: same as Hodgkins Lymphoma
Prognostic Markers: LDH, Performance status
Name 2 long term side effects of chemotherapy treatment for HL.
Pulmonary Fibrosis
Cardiomyopathy
What is Non Hodgkins Lymphoma?
Neoplastic proliferation of lymphoid cells. Originates in lymphoid tissue (lymph nodes, bone marrow, spleen).
No Reed Sternberg cells on biopsy.
Can have a B or T cell lineage/
Presentation of Non Hodgkin Lymphoma
Painless Lymphadenopathy, compression symptoms, B/constitutional symptoms (weight loss, fever, low grade fever, night sweats, pruritis, fatigue)
What are the 3 ways of classifying NHL?
- Mature or Immature
- Histology: High Grade (Very Aggressive, Aggressive), Low Grade (Indolent)
- Lineage: B or T cell
What are the main T-cell lymphomas? (NHL’s with T cell lineage)
Anaplastic large cell lymphoma Peripheral T cell Lymphoma Adult T cell leukaemia/lymphoma Enteropathy-associated T cell lymphoma (EATL) Cutaneous T cell Lymphoma
What are the main B cell Lymphomas?
Burkitt's Diffuse Large B-Cell (DLBC) Mantle cell Lymphoma Follicular Mucosal Associated Lymphoid Tissue (MALT)
Diffuse Large B cell Lymphoma Low Grade/High Grade B/T cell % of NHL Epidemiology
Aggressive (High Grade) B cell NHL
30-40% of all NHL
Epi: Middle aged and elderly
What mixture of drugs is used in R-CHOP (chemotherapy regimen)?
Rituximab, Cyclophosphamide, Adriamycin, Vincristine, Prednisolone
Follicular NHL
Low Grade/High Grade
B/T cell
% of NHL
Indolent/Low Grade B cell NHL
35% of NHL
What genetic mutation is associated with Follicular NHL? What is the physiological result of this mutation?
t(14:18) translocation, results in over expression of bcl2, an anti-apoptosis protein
MALT Low Grade/High Grade B/T cell % of NHL Epidemiology
Indolent/Low Grade B Cell NHL
(Marginal zone NHL involving extranodal lymphoid tissue)
8% of NHL
Epi: 55-60yo
What causes MALT? What disease is it associated with?
Chronic antigen stimulation
H.pylori –> gastric MALT lymphoma
Sjorgen’s syndrome –> parotid MZL (Marginal Zone Lymphoma)
Hashimotos Thyroiditis –> Thyroid MZL
