LYMPHOMA Flashcards by

What proportion of lymphoma’s are non-Hodgkins lymphoma?

85%

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What is a lymphoma?

A collection of white blood cells

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What are the two types of lymphocytes that may form a lymphoma?

B and T

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What are the markers that you should look for which would indicate a B cell lymphoma?

CD-19

CD-20

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What are the markers that you should look for which would indicate a T cell lymphoma?

CD-4

CD-8

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What characterises Hodgkin’s lymphoma?

The presence of Reed-Sternberg cells

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What percentage of non-Hodgkin’s lymphomas are B cell lymphomas?

80%

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What percentage of the B cell non-Hodgkin lymphomas are follicular?

50%

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What is the difference between follicular and diffuse lymphomas?

Follicular is more differentiated - less proliferative - and restricted to lymph nodes
Diffuse is more primitive - more proliferative - and more widespread

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Are T-cell lymphomas follicular or diffuse?

Diffuse. Follicular is only in the lymph node, which is where the B cell reside.

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From a biopsy, what factors might help you work out how proliferative the cells of lymphoma are?

Cleaved cells are less proliferative
Smaller cells are less proliferative
Mature cells (more like normal cells) are less proliferative
Follicular cells (versus diffuse) are less proliferative

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What are the main low grade non-Hodgkins lymphomas?

Small lymphocytic lymphoma
Follicular lymphoma
Marginal zone B-cell lymphoma (Extranodal lymphoma)
Mantle cell lymphoma (sometimes considered intermediate grade)
Lymphoplasmacytic lymphomas (including Waldenstrom’s)
Mycoisis fungoides

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What are the features of small lymphocytic lymphoma?

B cell
Diffuse
Mature cells
Small cells
CD5 marker positive
CLL without high white cell count in the blood

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What is the translocation responsible for 85% of the follicular lymphoma?

t(14,18) Bcl-z which leads to dysfunction of apoptosis

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What are the features of follicular lymphoma?

B cell
Follicular
Cleaved cells
Small cells
Lymphoma of follicle centre B cells (centrocytes and centroblasts)
Most common type of low grade lymphoma

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What are the positive markers in follicular lymphoma?

CD19
CD20 - this is a target for some treatments
CD10
CD22

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What are the features of marginal zone B-cell lymphoma (extranodal lymphoma)?

B cell
Small cell
Associated with mucosa-associated lymphoid tissue (MALT)
Lymphoma starts in the mucosa not in the lymph nodes

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Where is the most common place for MALT lymphomas to develop?

Stomach

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Other than the stomach, where are the common places for MALT lymphomas to develop?

Small bowel
Salivary glands
Thyroid glands
Tear glands
Lungs

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What is the infection associated with MALT lymphomas?

H. pylori

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Are marginal zone B-cell lymphomas positive or negative for CD5?

Negative

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Are marginal zone B-cell lymphomas positive or negative for CD10?

Negative

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What is the marginal zone, which is affected by marginal B-cell lymphomas?

The marginal zone is the region at the interface between the non-lymphoid red pulp and the lymphoid white-pulp of the spleen or lymph node.

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What are the lymphomas associated with the protein marker CD5?

Small lymphocytic lymphoma

Mantle cell lymphoma

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What are the features of mantle cell lymphoma?

B cell | Found in the mantle zone which surrounds normal germinal centre follicles

What is the chromosomal translocation associated with mantle cell lymphoma?

t(11:14)

What is the protein that mantle cell lymphoma cells tend to overexpress as a result of the translocation t(11:14)?

Cyclin D1

What are the features of Waldenstrom's macroglobulinaemia?

B cell Excessive amounts of IgM Causes hyperviscosity

What are the features of mycosis fungoides?

T cell lymphoma | Generally affects the skin

What are the main high-grade non-Hodgkin lymphomas?

Diffuse large B cell lymphoma Burkitt's lymphoma Peripheral T cell lymphoma Lymphoblastic lymphoma

What is the most common type of high-grade non-Hodgkin lymphoma?

Diffuse large B cell lymphoma

Is diffuse large B cell lymphoma more common in men or women?

Men

Which group of patients are most likely to develop Burkitt's lymphoma?

Children and young adults

What are three main clinical variants of Burkitt's lymphoma?

Endemic Sporadic Immunodeficiency-associated lymphoma

What infections are associated with endemic Burkitt's lymphoma?

EBV | Malaria is believed to reduced resistance to EBV

Which parts of the body are typically involved in endemic Burkitt's lymphoma?

``` Facial bones especially jaw Distal ileum Caecum Ovaries Kidney Breast ```

Which parts of the body are typically involved in sporadic Burkitt's lymphoma?

Ileocecal

What is most commonly associated with immunodeficiency lymphoma?

HIV

What is the gene affected in Burkitt's lymphoma?

c-myc gene

What is the most common translocation associated with Burkitt's lymphoma?

t(8;14)

Are Reed-Sternberg cells usually positive or negative for CD20?

Negative

What markers are Reed-Sternberg cells usually positive for?

CD30 and CD15

What is the main recognised risk factor for Hodgkin's lymphoma?

EBV infection

Are T cells or B cells affected in Hodgkin's lymphoma?

Most commonly B cells.

What are the B symptoms of lymphoma?

Weight loss Night sweats Fever

Apart from the B symptoms, what are the other classic symptoms of lymphoma?

``` Lymphadenopathy Loss of apetite Fatigue Respiratory distress Itching Hepatosplenomegaly Symptoms of bone marrow failure ```

What is the definitive method of diagnosis for lymphoma?

Lymph node biopsy

What tests might be carried out on the lymph node biopsy?

Immunophenotyping Flow cytometry FISH (fluorescence in situ hybridisation)

What is the system used for staging lymphomas?

Ann-Arbor staging system

What does stage I mean in the Ann-Arbor staging system of lymphomas?

The cancer is located in a single region, usually one lymph node and the surrounding area. Stage I often will not have outward symptoms.

What does stage II mean in the Ann-Arbor staging system of lymphomas?

The cancer is located in two separate regions, an affected lymph node or organ and a second affected area, and that both affected areas are confined to one side of the diaphragm - that is, both are above the diaphragm, or both are below the diaphragm.

What does stage III mean in the Ann-Arbor staging system of lymphomas?

The cancer has spread to both sides of the diaphragm, including one organ or area near the lymph nodes or the spleen.

What does stage IV mean in the Ann-Arbor staging system of lymphomas?

Diffuse or disseminated involvement of one or more extralymphatic organs, including any involvement of the liver, bone marrow, or nodular involvement of the lungs.

What does the A or B mean in the staging of lymphoma?

Absence or presence of B symptoms

What does the S mean in the staging of lymphoma?

Splenic involvement

What does the E mean in the staging of lymphoma?

Disease is "extranodal" (not in the lymph nodes) or has spread from lymph nodes to adjacent tissue.

What stage would you assign to a lymphoma where two affected lymph nodes are found both above the diaphragm in someone experiencing night sweats?

Stage IIB

What stage would you assign to a lymphoma where two lymph nodes above the diaphragm are found to be affected as well as the spleen in someone experiencing frequent fevers?

Stage IIIB S

What grade of lymphoma are most successfully treated?

High grade

What is the initial approach to the treatment of low-grade lymphomas?

Wait and watch

What is an alternative approach to the wait and watch strategy in someone with follicular lymphoma?

Rituximab

What is the approach for someone diagnosed with high-grade lymphoma?

Aggressive chemotherapy

What is the chemotherapy regimen often used in the treatment of high-grade lymphoma?

``` CHOP Cyclophosphamide Hydroxydaunorubicin (or Adriamycin) Oncovin (vincristine) Prednisolone ``` Rituximab can be added to make R-CHOP

How is early staged Hodgkin's lymphoma treated?

Often with radiotherapy alone as long as it can be localised

What is the chemotherapy regimen used in more advanced Hodgkin's lymphoma treated?

``` ABVD Adriamycin (Hydroxydaunorubicin in the CHOP regime) Bleomycin Vinblastine Dacarbazine ```

After relapse of high-grade lymphoma, what is the treatment of choice?

High-dose chemotherapy followed by autologous stem cell transplantation

What is the peak age for Hodgkin's lymphoma?

15-35