Lymphoproliferative disorders Flashcards
How can lymphoma present?
lymphadenopathy or
extranodal disease or
bone marrow involvement
Systemic B symptoms
weight loss >10% in 6 months fever drenching night sweats pruritis fatigue
How to tell what type of lymphoma it is
biopsy - LN
How to tell where the lymphoma is
CT and clinical exam
Classification of “lymphoma”
Hodgkin
non Hodgkin - high grade and low grade
Lymphoproliferative disorders
ALL
CLL
Hodgkin lymphoma
non Hodgkin lymphoma
high grade NHL common type
diffuse large B cell lymphoma
low grade NHL common type
follicular
ALL - blood signs
high WCC, low Hb and low platelets
diagnosing ALL
> 20% lymphoblasts in the bone marrow
ALL - age
75% under 6 years
Are most ALL B or T cell lineages?
B
ALL - history of symptoms
bone marrow failure
bone/joint pain
Standard treatment for ALL
induction chemo
consolidation therapy
CNS directed treatment - intrathecal
maintenance treatment for 18 months
Who would receive a stem cell transplant for ALL?
high risk
newer therapies for ALL
bispecific T cell engagers - BiTe
CAR
problems with newer therapies for ALL
cytokine release syndrome
neurotoxicity
ALL poor risk factors
increasing age increasing WCC immunophenotyped cytogenetics - Philadelphia gene slow/poor response to treatment
CLL diagnosis
blood >5x10 9 lymphocytes, bone marrow >30% lymphocytes
Presentation of CLL
often asymptomatic
frequent findings = splenomegaly, bone marrow failure, lymphadenopathy, fever, sweats
less common = hepatomegaly, infections, weight loss
Associated findings with CLL
immunoparesis
haemolytic anaemia
Staging for CLL
binets
Indication for treatment - CLL
massive lymphadenopathy
progressive splenomegaly
progressive bone marrow failure
systemic symptoms
CLL treatment
often nothing
cytotoxic chemo
monoclonal ab
novel agent eg tyrosine kinase inhibitor
CLL poor prognostic factors
advanced disease - Binet’s
atypical lymphocyte morphology
loss/mutation p53
rapid lymphocyte doubling time
Staging lymphoma
LN biopsy
CT
bone marrow aspirate and trephine
High grade NHL
aggressive and fast growing
combo chemo required
can be cured
low grade NHL
indolent, often asymptomatic
responds to chemo
incurable
combo chemo for NHL
Anti CD20 mab and chemo
Epidemiology of HL
30% of all lymphomas
bimodal age curve
EBV
males
HL treatment
combo chemo (ABVD) +/- radiotherapy
monoclonal ab (anti-CD30)
immunotherapy
PET scan to monitor response
