Lymphoma Flashcards
What are the two classes of lymphoma
Hodgkin’s and non-Hodgkin’s
What chemotherapy is used for DLBCL-NHL?
R-CHOP
Describe how high calcium leads to pre-renal AKI?
High calcium causes water to move out of the cells, causing dehydration, PTH is low, polyuria and polydipsia
What is rituximab?
Targets B cells Chimeric human-murine monoclonal antibody Directed to CD20 Cell mediated toxicity/complement Induction of apoptosis
How does the material from the tumour exit the body when rituximab is given?
Broken down into proteins and amino acids - turns into uric acid
Through the kidney
What is a complication of rituximab treating lymphoma
Can develop gout and intrinsic renal failure
What is tumour lysis syndrome?
Breakdown of products of cancer affecting the kidney
What is the management of tumour lysis syndrome
Anticipate
Hydrate and allopurinol for low/medium risk
Rasburicase (recombinant urate oxidase)
Dialysis
What are the causes of NHL?
Immunodeficiency - primary and secondary
Age
Infection - HTLV-1, EBV, H.pylori
What happens to the electrolytes in tumour lysis syndrome
Increased uric acid, potassium and phosphorous
Lower calcium due to phosphorous soaking this up
Describe the staging of lymphoma
Ann Arbor
1 - single lymph node
2 - >2 sites, same side of diaphragm
3 - both sides of diaphragm
4 - Diffuse/disseminated involvement of >1 extra lymphatic organ
Stage A - no systemic symptoms other than pruitis
Stage B - B symptoms present
Stage E - localised extra-nodal extension - does not advance the stage and denoted by subscript
Describe follicular NHL
30-40%
Majority disseminated disease at diagnosis
Median survival 15-20yrs
Not curable
When do you start treatment for NHL?
When patient becomes symptomatic
Describe the treatment of high-grade lymphoma
Chemo/radiotherapy - potentially curable
R-CHOP - short/long course
What are the two main types of NHL?
Follicular - slow growing
Diffuse large B cell - aggressive
Which virus is HL associated with?
EBV
Which age group does Hodgkin’s most commonly affect
Younger people (15-24yo) but also can affect the elderly - two peaks
What are lymphomas?
Disorders caused by malignant proliferations of lymphocytes. These accumulate in the lymph nodes, peripheral blood or infiltrate organs
What characteristic cells are found in Hodgkin’s lymphoma
Reed Sternberg cells - Mirror nuclei
What are the RF for HL
An affected sibling
EBV
SLE
Post-transplantation
List the symptoms of HL
Enlarged, non tender, rubbery superficial lymph node (mostly cervical, but can be axillary or inguinal) - node size may fluctuate and become matted
Constitutional upset - fever, weight loss, night sweats, Pruitus, lethargy
Alcohol induced lymph node pain
Mediastinal lymph node involvement may cause mass effect - bronchial or SVC obstruction or direct extension (pleural effusion)
List the signs of HL
Lymphadenopathy
Cachexia
Anaemia
Spleno or hepatomegaly
What tests would you do if suspecting lymphoma
Lymph node excision biopsy if possible, image-guided needle biopsy, laparotomy or mediastinoscopy
Bloods - FBC, film, ESR, LFT, LDH, urate, Ca2+
Imaging - CXR, CT/PET CAP
What are the B symptoms
Weight loss >10% in last 6 months
Unexplained fever >38%
Night sweats - needing to change clothes
Describe the treatment of HL
Chemoradiotherapy - radiotherapy and short course of chemo for stages I-A and II-A (<3 areas of involvement). Longer courses of chemo for II-A with >3 areas of involvement through to IV-B
ABVD - Adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine cures 80%
More intensive regimes if poor prognosis/advanced disease
In relapsed disease, high dose chemo followed by autologous stem cell transplant
What are the complications of radiotherapy?
Increased risk of some solid tumours
IHD
Lung fibrosis
Hypothyroidism
What is the 5 year survival for HL?
I-A lymphocyte predominant >95%
IV-B lymphocyte depleted <40%
Name the different subtypes of HL and state the percentage of cases and prognosis
Nodular sclerosis (70%) - good prognosis Mixed cellularity (20-25% - good prognosis Lymphocyte rich (5%) - good prognosis Lymphocyte depleted (1%) - poor prognosis
Which two subtypes of HL have a worse prognosis in a HIV positive patient
Mixed cellularity
Lymphocyte depleted
What is NHL?
Group of lymphomas without reed-sternberg cells
Mostly derived from B cell lines
What is the most common NHL
Diffuse large B cell lymphoma
What causes NHL
Immunodeficiency - drugs and HIV HTLV-1 H.Pylori Toxins Congenital
Give some signs and symptoms of NHL
Superficial lymphadenopathy
Extranodal disease - gut (gastric and non-gastric MALT , small bowel lymphoma - diarrhoea, vomiting, abdo pain and weight loss), skin (clonal T cells in mycosis fungiodes), oropharynx (waldeyers ring lymphoma causes sore throat and obstructed breathing), bone, CNS, lung
Fever, night sweats, weight loss
Pancytopenia - anaemia, infection and bleeding (thrombocytopenia)
What tests would you request when suspecting NHL?
Blood - FBC,U&Es, LFT, LDH Marrow and node biopsy - classification Staging - Ann Arbor system - CT and PET CAP Cytology of any effusion LP for CSF cytology if CNS signs
Describe the treatment of high grade NHL
R-CHOP - Rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine and prednisolone
Describe how rituximab works
Kills CD20 positive cells by antibody-directed cytotoxicity and apoptosis induction
Also sensitises cells to CHOP
