Lymphoma Flashcards
Hodgkin
Commonly presents locally, with firm lymphadenopathy. Palpable firm lymph nodes, Mediastinal mass, some patient have B symptoms, splenomegaly possible.
Severe pruritis w/o clear etiology may be clue
Stage I/II w/o B symp: radiation alone or with short chemo
Stage 3/4 or with B symp (any stage): full chemo.
Chemo is generally (ABVD) doxorubicin, bleomycin, vinblastine, dacarbazine. Rituximab if CD20+.
Stage 1 disease (ann arbor)
Involvement of single node or region. Involvement of single extralymphatic site.
Stage 2 disease
Involvement of 2 or more lymph nodes on same side of diaphragm.
May include localized extralymphatic involvement on same side of diaphragm.
Stage 3
Involvement of lymph node regions on both sides of diaphragm. May include spleen.
Hodgkin: Disease limited to upper abdomen (spleen, splenic/hilar/celiac or porthahepatic nodes.
stage 4
Disseminated extralymphatic disease involving one or more organs.
Isolated extralymphatic disease with distant non-regional node invovlement.
Follicular lymphoma
Indolent
CD 10, 19, 20, 22, small cells on morphologic analysis.
Dx with biopsy, t14:18, BCL2 gene
Generally lymphadenopathy is the only symptom.
No tx until symptoms, if local symptoms do field radiation. Otherwise tx is r-chop, r-cvp
MALT
Indolent
B cell, CD20
Most are localized (stage 1-2), generally from H.pylori
Most remit with pylori tx
If not confined to stomach tx with R-CVP
If spleen –> splenectomy
CLL
Generally asypmtomatic, identified by relative lymphocytosis on CBC
CD 5 and CD23
Ibrutinib
ITP and Hemolytic anemia is common
Transformation to large cell lymphoma is possible
Hairy Cell Leukemia
Accumulation of malignant B cells in bone marrow –> pancytopenia and progressive splenomegaly w/o lymphadenopaty
Dry tap on BM biopsy
B cells have thread-like projections emanating from cell surface
tx: cladribine + rituxan
Diffuse large B cell
Most common type, very aggressive
B symptoms and advanced stage at presentation
R-CHOP is standard
Radiation therapy for bulky disease
Burkitt and large cell lymphoma
type of large cell
tx is same as ALL - R-hyper-CVAD for CD20+ disease
Burkitt may be localized in presentation but is considered systemic.
Mantle Cell
Over expression of Cyclin D-1
Translocation t(11:14)
generally advanced at presentation: lymphadenopathy, wt loss, fever, diffuse involvement
elevated LDH and B2-microglobulin are clues
Cutaneous T-Cell NHL
Express CD4 and infiltrate skin and initially cause rash (mycosis fungoides) and occasionally circulate in blood (Sezary syn).
Large CD4 T cells have cerebriform-appearing nuclei
early stage (skin only) tx topical glucocorticoids, retinoids (as needed) and psoralen and UV light with interferon alpha
stage 3/4 (extensive skin and organ involvment): chemo with MTX, gemcitabine and CHOP
