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CSP > Lymphoma/Myeloma > Flashcards

Lymphoma/Myeloma Flashcards

1
Q

What progenitor cells do lymphomas arise from?

A

Common lymphoid progenitor cells –> T and B lymphocytes

About 90% B cell and the other 10% are T and NK cell

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2
Q

What are the two main types of lymphoma?

A

Non-Hodgkin (either low or high grade)

Hodgkin (various types)

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3
Q

Features of lymphoma (7)

A 
Lymphadenopathy
Fever
Night sweats
Weight loss
Fatigue
Itching
Pain on drinking alcohol (HL)
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4
Q

What is Ann Arbor staging?

A

There are four stages (I-IV):
Stage 1 - cancer is located in a single region, usually one lymph node and the surrounding area
Stage 2 - cancer is located in an affected lymph node/organ and a second affected area, and both affected areas are confined to one side of the diaphragm (i.e. above or below)
Stage 3 - cancer has spread to both sides of the diaphragm
Stage 4 - diffuse or disseminated involvement of one or more extralymphatic organs

A = no associated symptoms
B = unexplained fever, night sweats and wgt loss >10% in last 6 months
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5
Q

How are lymphomas diagnosed?

A

Biopsy - histological appearance, immunostaining

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6
Q

What are Reed Sternberg cells typical of?

A

Hodgkin’s lymphoma

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7
Q

What genetic lesion is associated with follicular lymphoma?

A

t(14:18) – BCL 2

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8
Q

Diffuse large B cell lymphoma (DLBCL) - what is the typical population who have this?
Are B symptoms common?

A

60-80 year olds, more common in Caucasians

COMMON

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9
Q

What is the most common non-Hodgkin lymphoma?

A

DLBCL (then FL)

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10
Q

Is DLBCL curable?
Is it aggressive or slow growing?
How common in extranodal involvement?
What stage are majority of patients?

A

Yes
Aggressive
In 20%
Stage I and II

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11
Q 
Follicular lymphoma (FL) - what is the typical population who have this?
Are B symptoms common?
A

45-65 y.o, more common in Caucasians

Uncommon

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12
Q

Is FL curable?
Is it aggressive or slow growing?
How common in extranodal involvement?
What stage are majority of patients?

A

Controllable but generally not curable
Slow growing
Uncommon
Stage III and IV

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13
Q

Hodgkin’s lymphoma (HL) - what is the typical population who have this?
Are B symptoms common?

A

15-34 and >55
male > female
40% have them

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14
Q

Is HL curable?
Is it aggressive or slow growing?
How common in extranodal involvement?
What stage are majority of patients?

A

Very curable
Aggressive
Rare
Stage I or II with 80% above the diaphragm

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15
Q

What viral infections are associated with lymphoma? (5)

A 
– EBV
– HIV
– HTLV
– Hepatitis C
– HHV 8
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16
Q

What bacterial infections are associated with lymphoma? (2)

A

H pylori

Chlamydia

17
Q

What inflammatory conditions are associated with lymphoma? (2)

A

– Coeliac disease

– Sjogren’s syndrome

18
Q

What medical exposures are associated with lymphoma? (3)

A

– Ionising radiation
– Benzene
– Immunosuppression

19
Q

What are risk factors of a poor prognosis in lymphoma?

A 
Age >60
Ann Arbor Stage III/IV
Haemoglobin <120g/l
No of nodal areas >4
LDH>ULN
20
Q

What is a score used for prognosis in lymphoma?

A

FLIPI

21
Q

What are the treatments for lymphoma?

A 
• Watch and wait
• H.pylori eradication/HAART
• Single agent or combination chemotherapy +/-
 monoclonal antibodies
• Antibody-drug/radioisotope conjugates
• Pathway inhibitors
• Engineered CAR-T cells
• Radiotherapy
• Steroids
• Stem cell transplantation
22
Q

What does rituximab bind to?

A

CD20

23
Q

What chemo combination is given for non-Hodgkin lymphoma?

A

R-CHOP

This is rituximab, cyclophosphamide, doxorubicin (hydroxydaunomycin), vincristine (Oncovin ®), and prednisolone.

24
Q

What chemo combination is given for Hodgkin lymphoma?

A

ABVD

This is doxorubicin (Adriamycin®), bleomycin, vinblastine (Velbe ®), and dacarbazine (DTIC).

25
Q

What cells do myelomas come from?

A

Plasma cells

26
Q

What is a myeloma?

A

Malignant neoplasm of plasma cells

27
Q

Demographics of myeloma (age, gender, race)?

A
  • Elderly – avg age 70
  • Male>Female
  • Black>White
28
Q

Myeloma - may be preceded by…?

Majority have _____ in serum?

A

MGUS

Paraprotein

29
Q

How is myeloma diagnosed?

A

Urine and serum electrophoresis
Bone marrow examination
Skeletal survey
Bloods

30
Q

OLD CRAB - what does this stand for?

A 
OLD - old age
C - calcium elevated
R - renal failure
A - anaemia
B - bone lytic lesions
31
Q

How is myeloma treated?

A 
Huge number of new treatments
– Thalidomide, Lenalidomide, Pomalidomide
– Bortezomib, Carfilzomib
– Monoclonal antibodies?
– CAR T cells?

More ‘traditional’ chemotherapy
Autologous stem cell transplantation
Radiotherapy

CSP (20 decks)

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