Lymphoma And Myeloma Flashcards
Describe the patient presentation of NHL
- painless, rubbery lymphadenopathy
- splenomegaly
- extranodal disease
- B symptoms: night sweats/weight loss/unexplained fever
- anaemia
How is lymphoma staged?
Ann-Arbor classification:
- stage 1: single lymph node group
- stage 2: more than 1 group on same side of diaphragm
- stage 3: lymph node groups involved on both sides of diaphragm (including spleen)
- stage 4: extranodal involvement
A or B added to signify absence or presence of B symptoms
What factors do you have to consider when thinking about treatment of lymphoma?
- the type of lymphoma (is it curable or not?)
- is patient symptomatic?
- stage of lymphoma
- age and performance status
- co-morbidities
- support
Describe features of follicular lymphoma
- indolent and low grade
- caused by a translocation of chromosome 14 18 which codes for the BCL2 gene - anti-apoptosis
- slow growing but reduced cell death
- B symptoms less common
- usually incurable
What are the principles of treatment of follicular lymphoma?
Since the majority of times it is incurable, management is of symptoms and preventing end organ damage
- early stage can be treated with radiotherapy
- if symptomatic/bulky disease/end organ compromise = rituximab + chemo with maintenance rituximab to reduce recurrence risk
Describe diffuse large B cell lymphoma:
- aggressive and high grade
- cells resemble activated B cells
- associated with various translocations and genetic abnormalities
- high proliferation fraction
- variable rate of cell death
- tumours may express BCL2 or IL10
- curable most of the time
What is the typical presentation of diffuse large B cell lymphoma?
- rapidly growing LN mass
- extra-nodal problems
Describe the treatment for diffuse large B cell lymphoma
Aggressive chemotherapy with intention to cure:
- early stage A1 = 3 cycles of R-CHOP + radiotherapy
- all other stages = 6 cycles of R-CHOP
Describe the features of Burkitts Lymphoma
- commonest high grade lymphoma in children
- cells resemble proliferating germinal centre cells
- associated with 8 14 translocations (MYC gene)
- high rate of proliferation and cell death
- risk of tumour lysis syndrome
Describe tumour lysis syndrome
When lots of cancer cells die and release their contents of into the environment (toxic metabolites) - medical emergency
What is the treatment for Burkitts lymphoma?
- intensive chemo therapy (CODOZ-M/IVAC) with intention to cure
- if elderly will have poorer outcomes due to inability to tolerate
Describe the classification of HL
HL can be divided into classical (>90%) and nodular lymphocyte predominant.
Classical can be divided into:
- nodular sclerosis
- mixed cellularity
- lymphocyte rich
- lymphocyte depleted
Describe some features of classic HL
- high grade with a component of reactive cells
- neoplastic cell is binucleate Reed Sternberg cells (resemble atypical B cells)
- look for any expression of CD30 (rituximab can directly target this)
- 40% of cases associated with EBV
Describe possible presentation of HL
- painless rubbery lymphadenopathy
- neck lump
- cough, SOB (due to large intestinal node)
- B symptoms possibly
- itch
- alcohol related pain in neck or chest
What is the treatment of HL
Stage 2B considered advanced
- early stage = combined modality
- advanced stage = chemotherapy (ABVD) given on days 1 and 15 of 28 day cycle, then bleomycin removed from cycles 3-6 if PET clear
