Lymphoproliferative disorders

Question 1

How might lymphoma present?

Answer 1

Weight loss
Fever
Drenching night sweats
Pruritis
General fatigue

Question 2

Where do leukaemias like ALL typically start?

Answer 2

Bone marrow

Where hematopoietic cells kept there before differentiating into progenitor cells

Question 3

What does ALL mean?

Answer 3

Acute lymphoblastic leukaemia

Question 4

What does CLL mean?

Answer 4

Chronic lymphocytic leukaemia

Question 5

Which is the most common kind of lymphoma?

Answer 5

High-grade non-hodgkin lymphoma

Most common of these is Diffuse Large B-cell lymphoma

Question 6

What is the most common low grade leukaemia?

Answer 6

Chronic lymphocytic leukaemia (CLL)

Question 7

Which cells are affected in ALL?

Answer 7

Lymphoid progenitor cells

These are meant to be the cells from which healthy lymphocytes differentiate

Question 8

How does ALL usually present?

Answer 8

Bilateral impaired vision loss
SOB
Bone marrow failure (Low platelets, WCC and platelets)
Wee dots of haemorrhage all over fundoscopy

Question 9

What are some histology results in ALL?

Answer 9

Large cells

Raised CD34 and TDT indicating immature cells

Question 10

How is ALL treated?

Answer 10

Combination chemo
Consolidation therapy for long term solution
If high risk then maybe stem cell (bone marrow) transplant

Question 11

What are BiTe molecules?

Answer 11

Bi-specific T cell engager
Guides immune system to send T cells after cancerous cells
Blinatumumab

Question 12

What is CAR T cell therapy?

Answer 12

Chimeric Antigen Receptor T cell
Patient’s healthy T cells harvested
Modified to express specific T cell receptors against CD-19 marker
Cultured then infused into patient

Question 13

What are some side effects of CAR T cell therapy?

Answer 13

Cytokine release syndrome (Fever, hypotension, dyspnoea)

Neurotoxicity (confusion, seizure, headache, coma)

Question 14

What are some risk factors for ALL?

Answer 14

Increasing age
Increased WCC
Poor treatment response
Genetic predisposition

Question 15

How is CLL diagnosed?

Answer 15

Slow growing
Cells normal mature lymphocytes
Easier to pick up as they carry many normal B lymphocyte markers

Question 16

How might CLL present?

Answer 16

Often asymptomatic and picked up accidentally
Bone marrow failure
Lymphadenopathy
Splenomegaly
Fever and sweats
Hepatomegaly
Infection
Weight loss

Question 17

What other conditions are associated with CLL?

Answer 17

Immune paresis

Haemolytic anaemia

Question 18

Describe a staging system for CLL.

Answer 18

Binet

Graded A-C

Question 19

How is CLL treated?

Answer 19

Often just watch and wait
Cytotoxic chemo
Monoclonal antibodies
Ibrutinab
Idelisib
Venetoclax

Question 20

What is Ibrutinib?

Answer 20

Bruton tyrosine kinase inhibitor

Question 21

What kind of cells are usually affected by non-hodgkin lymphoma?

Answer 21

B cell mostly

Sometimes T cells

Question 22

How is low grade non-hodgkins lymphoma treated?

Answer 22

Responds well to chemo

Question 23

How is high grade non-hodgkins lymphoma treated?

Answer 23

Combination chemo

Can be cured

Question 24

What are some associations of hodgkins lymphoma?

Answer 24

Epstein Barr virus

Familial and geographical clustering

Question 25

How is hodgkins lymphoma treated?

Answer 25

Combination chemo
Very sensitive to radiotherapy
Monoclonal antibodies
Immunotherapy

Question 26

How is response of hodgkins lymphoma to treatment tracked?

Answer 26

PET