Lymphomas Flashcards by Kayla Snyderman

diffuse large cell lymphoma - prognosis

intermediate grade
req aggressive chemo to get remission
cure possible w/ aggressive tx

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describe lymphoma staging

stage 1 = one group of lymph nodes on one side of diaphragm
stage 2 = 2 or more sites on same side of diaphragm
stage 3 = both sides of diaphragm or splenic involvement
stage 4 = diffuse or extra lymphatic organ involvement

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DLCBL flow cytometry

CD19+, CD20+

may have aberrant CD5 (normally a T cell marker)

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DLCBL pathology on lymph node biopsy

large B cells (cleaved or non-cleaved)

rounded or folded vesicular chromatin and 1-3 nucleoli

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IPI for determining DLBCL prognosis

lower score is better
>60yrs
LDH level
Extranodal involvement/ann arbor stage

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how to tx DLBCL

stage I or II - chemo and radiation combo

stage III and IV - chemotherapy alone (radiation doesn’t work b/c too diffuse)

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CHOP chemotherapy

cyclophosphamide, doxorubicin, prednisone
standard for DLCBL
+ add rituximab

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stem cell transplant for DLBCL?

yes, autologous!

for relapsed DLBCL

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lymph node morphology in follicular lymphoma

increased number of follicles, packed back to back with thin mantle zones

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characteristic cells in follicular lymphoma

centrocytes: small cleaved cells w/ indistinct nucleoli

and centroblasts: large cells w/ round/oval nuclei and prominent, multiple nucleoli –> determines grade

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follicular lymphoma flow cytometry

CD10+ - originates in follicle
CD19+, CD20+
BCL2 positive

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follicular lymphoma genetic abnormality

T(14;18)(q32;31)

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how do you treat follicular lymphoma grade III

like DLCBL (w/ CHOP + rituximab)

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why is follicular lymphoma grade I and II not curable?

Bcl2 translocation means cells won’t die

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FLIPI score - 5 criteria

1 point for each
age >60
Hgb 4 LN sites
stage III or IV
LDH elevated

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follicular lymphoma tx

initial: watch and wait
UNLESS: bulky/painful adenopathy, organ involvement, cytopenias, autoimmune cytopenias, B symptoms, high FLIPI
- if tx, stage I/IIA - radiation, stage IIB-IV gentle chemo (R-CVP)

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R-CVP

chemo for high grade follicular lymphoma
rituximab, cytoxan, vincristine, prednisone
rituximab significantly prolongs remission and survival

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transformed follicular lymphoma

follicular lymphoma –> DLBCL

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marginal zone lymphoma - 3 types

nodal marginal zone lymphoma
extranodal marginal zone lymphoma/MALT
splenic marginal zone lymphoma

MALT lymphoma

flow cytometry: positive B cell non-specific markers
assoc w/ H. pylori infection
ulcer sx

flow cytometry of mantle cell lymphoma

FMC7 positive

mantle cell lymphoma path

starry sky

large mantle zone

mantle cell immunophenotype and cytogenetics

CD20+, CD5+, CD23-, CD10-

t(11,14) –> overexpression of cyclin D

cytogenetics of mantle, marginal, and follicular

mantle cell: t(11,14)

marginal: t(11,18)
follicular: t(14,18)

mantle cell natural hx

worst characteristics of indolent and aggressive leukemic component 3-7 yr survival w/ chemo

mantle cell tx

chemo + autologous transplant - improves survival | allogenic transplant for cure

Burkitt's lymphoma

starry sky appearance | t(8:14) --> persistant expression of MYC (cell cycle on switch)

mycosis fungoides

T cell lymphoma infiltrating the skin Sezary cells, paltrier microabcesses w/ collection of T cells in the epidermis 3 stages: patch stage --> plaque stage --> tumor stage (death by staph or pseudomonas)

Hodgkin's lymphoma path

reed stenberg cells

Hodgkin's subtypes

1. nodular sclerosis - most common subtype of hodgkin's 2. lymphocyte rich = good 3. mixed cellularity = more extensive and aggressive 4. lymphocyte poor = also more aggressive

Hodgkin's cell markers

CD15 and CD30 + | but CD45 - (to distinguish from reactive process like EBV)

Hodgkin's presentation

generalized adenopathy, mediastinal mass, systemic symptoms, hepatosplenomegaly

Hodgkin's tx

early stages - chemo ABVD and radiation | late - just radiation

lymphoma and virus association

they are assoc - 25-40% of HIV pts get a malignancy - EBV and Burkitts - Hep C and NHL

who usually gets ALL?

children <6

bone marrow findings in ALL (T cell and B cell)

Blasts! TdT positive B-ALL: CD10, CD19 T-ALL: CD3, CD7 Cyogenetics: may have t(9,22) mutation - use gleevac in combo w/ chemo

ALL tx

induction w/ goal of remission - multidrug regin b/c tends to develop resistance quickly consolidation - 6-12 months of more chemo CNS prophylaxis autologous BM transplant (children) or allogenic (high risk children and adults)

where do you often see ALL metastasis?

CNS - do prophylaxis to prevent this

CLL - where does it fall on the spectrum

low grade - similar to follicular lymphoma | - indolent, but not curable

dx of CLL

lymphocytosis or adenopathy clonal expansion of abnormal B lymphocytes path of peripheral blood, BM, or lymph node biopsy

path of CLL

mature lymphocytes w/ clumped (soccer ball) chromatin) smudge cells erythroid precursors

immunophenotype of CLL

CD19, CD23, CD5 Monoclonal w/ kappa-lamba restriction very low density surface Ig, CD20

IgVh gene mutation

in CLL, impt for prognosis UNMUTATED = BAD (derived from immature cells) MUTATED = GOOD (derived from mature cells)

deletion 17P

p53 mutation | worst prognosis for CLL

deletion 13q

better prognosis for CLL

when should CLL be treated?

based on symptoms, NOT JUST ON POOR PROGNOSTIC INDICATORS

CLL tx

chemo mAb (rituzin) allogeneic transplant for pts who don't respond well