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Haem > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

Classification of lymphoma

A

Hodgkin’s have mirror-image nuclei (Reed Sternberg cells)

Non-hodgkin’s

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2
Q

HL types

A 
Typical HL (nodular sclerosing/mixed cell/ lymphocyte rich/ lymphocyte depleted (poor prognosis))
Nodular lymphocyte predominant HL
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3
Q

NHL types

A 
B cell (high grade (diffuse large b-cell most common) or low grade (follicular most common))
T cell (rarer)
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4
Q

HL risk factors

A

Affected sibling
EBV
SLE
Post-transplant

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5
Q

HL presentation

A

Non-tender, rubbery, spreading unilateral lymphadenopathy (generally cervical/ supraclavicular)
Pain when drinking alcohol
B symptoms (wt loss >10% 6mths, fever, night sweats)
Mediastinal masses in 80%, especially nodular sclerosis

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6
Q

Lymphoma tests

A

Lymph node excision biopsy is diagnostic
Raised ESR/ LDH/ lower Hb indicates worse prognosis
CXR may show mediastinal mass
PET/CT used for staging, bone marrow biopsy for NHL staging

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7
Q

Lymphoma staging

A

Ann Arbor
I - Confined to single lymph node region
II - 2+ lymph node regions on same side of diaphragm
III - Nodes on both sides of diaphragm involved
IV - Spread beyond nodes e.g. to liver/bone marrow
A/B - are B symptoms present
E - extra-nodal extension
X - >10cm bulk

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8
Q

HL treatment

A

I-A + II-A radiotherapy and short chemo courses
ABVD chemo - Adriamycin (doxyrubicin), Bleomycin, Vinblastine, Dacarbazine; stop bleomycin after 2nd cycle if CT/PET negative
Stem cell transplants in relapsed disease

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9
Q

HL prognosis

A

Very good, especially if earlier and lower stage
Lymphocyte predominant best prognosis
Worse if B symptoms present
<40% if IV-B lymphocyte depleted

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10
Q

NHL presentation

A

Superficial lymphadenopathy in 75%
Extranodal disease can be in gastric MALT/ non-MALT; skin; oropharynx
Pancytopenia symptoms if bone marrow involvement

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11
Q

NHL management

A

Low-grade generally incurable, watch and wait initially, radiotherapy if localised then R-bendamustine if symptomatic in later stages
R-CHOP for high-grade: Rituximab, Cyclophosphomide, hydroxydaunorubicin (Doxirubicin), Oncovin (vincristine), Prednisolone

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12
Q

NLPHL treatment

A

Radiotherapy
Bendamustine
R-CHOP if advanced

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13
Q

Rituximab in untreated follicular lymphoma

A

Kills CD20 +ve cells

Also useful as sensitises cells to CHOP, so cost-effective

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14
Q

What is CML

A

Uncontrolled clonal proliferation of myeloid cells

>80% have Philadelphia chromosome translocation t(9;22) forming BCR-ABL (tyrosine kinase activity)

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15
Q

CML presentation

A

Most commonly 40-60yrs, slightly more males
Splenomegaly/hepatomegaly
Anaemia/bruising
Chronic + insidious weight loss, fatigue, fever, sweats
Maybe gout, bleeding

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16
Q

CML tests

A

Very high WCC with spectrum of myeloid cells
Hb normal/dec
Inc urate + B12
Hypercellular bone marrow

17
Q

CML phases

A 
Chronic phase (mths-yrs) with few/no symptoms
Accelerated phase - increasing symptoms, spleen size and deranged counts
Blast transformation with features of acute leukaemia
18
Q

CML treatment

A

Imatinib or dasitinib/nilotinib/bosutinib for Ph +ve
Hydroxycarbamide
Lymphoblastic transformation pts may have AML treatment
Allogeneic stem cell transplantation is the only cure, but significant morbidity/mortality

19
Q

What is CLL

A

Commonest leukaemia

Hallmark is progressive accumulation of malignant clonal functionless B cells

20
Q

Staging and survival CLL

A

Rai stage:
0 - lymphocytosis alone - >13yrs
I - lymphocytosis + lymphadenopathy - 8yrs
II - lymphocytosis + spleno/hepatomegaly - 5yrs
III - lymphocytosis + Hb<110 - 2yrs
IV - lymphocytosis + platelets <100 - 1yr

21
Q

CLL presentation

A

Often asymptomatic, incidental FBC finding
Anaemic/infection prone
Weight loss, night sweats, anorexia if severe
Enlarged non-tender rubbery lympadenopathy
Spleno/hepatomegaly

22
Q

CLL tests

A

Lympocytes raised
Small mature lymphocytes + smear cells on blood film
Bone marrow involvement

23
Q

CLL complications

A

Autoimmune haemolysis
Infection
Marrow infiltration -> dec Hb/neuts/platelets
Richter’s transformation -> NHL

24
Q

CLL treatment

A

If symptomatic, fludarabine + rituximab ± cyclophosphamide 1st line
Ibrutinib, chlorambucil, bendamustine + ofatumumab also may help
Steroids for AIHA
Radiotherapy for lymphadenopathy/splenomegaly
Supportive care

25
Q

CLL progression

A

1/3 never progress
1/3 progress slowly
1/3 progress actively
Death often due to infection/transformation to aggressive NHL (Richter’s syndrome)

26
Q

Burkitt lymphoma features

A

Associated with EBV
Rapid proliferation so may present with compression
Starry sky appearance on lymph node biopsy

Haem (10 decks)

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