Lymphoma Flashcards by Adele Atkins

What are the two classes of lymphoma

Hodgkin’s and non-Hodgkin’s

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What chemotherapy is used for DLBCL-NHL?

R-CHOP

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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

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What is rituximab?

Targets B cells 
Chimeric human-murine monoclonal antibody 
Directed to CD20
Cell mediated toxicity/complement
Induction of apoptosis

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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

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What is a complication of rituximab treating lymphoma

Can develop gout and intrinsic renal failure

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What is tumour lysis syndrome?

Breakdown of products of cancer affecting the kidney

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What is the management of tumour lysis syndrome

Anticipate
Hydrate and allopurinol for low/medium risk
Rasburicase (recombinant urate oxidase)
Dialysis

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What are the causes of NHL?

Immunodeficiency - primary and secondary
Age
Infection - HTLV-1, EBV, H.pylori

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What happens to the electrolytes in tumour lysis syndrome

Increased uric acid, potassium and phosphorous

Lower calcium due to phosphorous soaking this up

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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

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Describe follicular NHL

30-40%
Majority disseminated disease at diagnosis
Median survival 15-20yrs
Not curable

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When do you start treatment for NHL?

When patient becomes symptomatic

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Describe the treatment of high-grade lymphoma

Chemo/radiotherapy - potentially curable

R-CHOP - short/long course

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What are the two main types of NHL?

Follicular - slow growing

Diffuse large B cell - aggressive

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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