Lymphoproliferative disorders

Question 1

How can lymphoma present?

Answer 1

lymphadenopathy or
extranodal disease or
bone marrow involvement

Question 2

Systemic B symptoms

Answer 2

weight loss >10% in 6 months 
fever 
drenching night sweats 
pruritis 
fatigue

Question 3

How to tell what type of lymphoma it is

Answer 3

biopsy - LN

Question 4

How to tell where the lymphoma is

Answer 4

CT and clinical exam

Question 5

Classification of “lymphoma”

Answer 5

Hodgkin

non Hodgkin - high grade and low grade

Question 6

Lymphoproliferative disorders

Answer 6

ALL
CLL
Hodgkin lymphoma
non Hodgkin lymphoma

Question 7

high grade NHL common type

Answer 7

diffuse large B cell lymphoma

Question 8

low grade NHL common type

Answer 8

follicular

Question 9

ALL - blood signs

Answer 9

high WCC, low Hb and low platelets

Question 10

diagnosing ALL

Answer 10

> 20% lymphoblasts in the bone marrow

Question 11

ALL - age

Answer 11

75% under 6 years

Question 12

Are most ALL B or T cell lineages?

Answer 12

B

Question 13

ALL - history of symptoms

Answer 13

bone marrow failure

bone/joint pain

Question 14

Standard treatment for ALL

Answer 14

induction chemo
consolidation therapy
CNS directed treatment - intrathecal
maintenance treatment for 18 months

Question 15

Who would receive a stem cell transplant for ALL?

Answer 15

high risk

Question 16

newer therapies for ALL

Answer 16

bispecific T cell engagers - BiTe

CAR

Question 17

problems with newer therapies for ALL

Answer 17

cytokine release syndrome

neurotoxicity

Question 18

ALL poor risk factors

Answer 18

increasing age 
increasing WCC
immunophenotyped
cytogenetics - Philadelphia gene
slow/poor response to treatment

Question 19

CLL diagnosis

Answer 19

blood >5x10 9 lymphocytes, bone marrow >30% lymphocytes

Question 20

Presentation of CLL

Answer 20

often asymptomatic
frequent findings = splenomegaly, bone marrow failure, lymphadenopathy, fever, sweats
less common = hepatomegaly, infections, weight loss

Question 21

Associated findings with CLL

Answer 21

immunoparesis

haemolytic anaemia

Question 22

Staging for CLL

Answer 22

binets

Question 23

Indication for treatment - CLL

Answer 23

massive lymphadenopathy
progressive splenomegaly
progressive bone marrow failure
systemic symptoms

Question 24

CLL treatment

Answer 24

often nothing
cytotoxic chemo
monoclonal ab
novel agent eg tyrosine kinase inhibitor

Question 25

CLL poor prognostic factors

Answer 25

advanced disease - Binet's atypical lymphocyte morphology loss/mutation p53 rapid lymphocyte doubling time

Question 26

Staging lymphoma

Answer 26

LN biopsy CT bone marrow aspirate and trephine

Question 27

High grade NHL

Answer 27

aggressive and fast growing combo chemo required can be cured

Question 28

low grade NHL

Answer 28

indolent, often asymptomatic responds to chemo incurable

Question 29

combo chemo for NHL

Answer 29

Anti CD20 mab and chemo

Question 30

Epidemiology of HL

Answer 30

30% of all lymphomas bimodal age curve EBV males

Question 31

HL treatment

Answer 31

combo chemo (ABVD) +/- radiotherapy monoclonal ab (anti-CD30) immunotherapy PET scan to monitor response