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haematology > lymphoproliferative disorders > Flashcards

lymphoproliferative disorders Flashcards

1
Q

leukaemia

A

cancer seen in the blood

progressive, malignant disease of blood forming organs
distorted proliferation + development of leukocytes and their precursors in blood and bone marrow

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2
Q

lymphoma

A

cancer of lymphoid origin

can present with: lymphadenopathy, extranodal involement, bone marrow invovlement

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3
Q

B symptoms

A 
weight loss
fever
night sweats 
pruritus
fatigue
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4
Q

diagnosing leukaemia/lymphoma: biopsy

A

lymph node, bone marrow

tells us what type it is - makes diagnosis

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5
Q

diagnosing leukaemia/lymphoma: clinical exam and imaging

A

CT
extent and staging of disease
prognosis
can sometimes influence treatment

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6
Q

acute lymphoblastic leukaemia originations

A

lymphoid progenitor cells

bone marrow

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7
Q

lymphoma/chronic lymphocytic leukaemia originations

A

B lymphocytes
T lymphocytes

lymph nodes

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8
Q

multiple myeloma originations

A

plasma cells

bone marrow

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9
Q

lymphoma subsets

A

hodgkin lymphoma

non-hodgkin lymphoma (high or low grade)

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10
Q

lymphoproliferative disorders

A

ALL
CLL
Hodgkin’s lymphoma
non-hodgkin’s lymphoma

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11
Q

ALL

A

cancerous disorder of lymphoid progenitor cells

no differentiation, rapid uncontrolled growth and accumulation

75% cases <6yrs
74-90% B cell lineage

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12
Q

ALL risk factors

A

<5yrs
mid 80s
smoking

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13
Q

ALL features

A 
impaired vision
retinal haemorrhages on fundoscopy 
weight loss, fever, fatigue
SOB, dizzy
anaemia, thrombocytopenia, leucocytosis
>20% cells in bone marrow lymphoblasts
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14
Q

ALL investigations

A

FBC, WCC, Hb, platelets

bone marrow aspiration

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15
Q

ALL cell characteristics

A

large cells
express CD19
express CD34, TFT (markers of early, immature cells)

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16
Q

ALL standard Rx

A
  • induction chemotherapy to obtain remission (multi-agent)
  • consolidation therapy to maintain remission
  • CNS directed therapy: through LP, methotrexate
  • maintenance Rx 18mo
  • STC if high risk recurrence/relapse
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17
Q

ALL newer therapies

A

bi-specific T cell engagers

chimeric antigen receptor T cells

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18
Q

ALL: T cell immunotherapies side effects

A

cytokine release syndrome: fever, hypotension, SOB

neurotoxicity; confusion w normal conscious level, headache, focal neurology, seizures

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19
Q

ALL poor prognostic factors

A

inc age - inc risk relapse
increased WCC
slow/poor response to Rx

20
Q

CLL

A

indolent lymphoproliferative disorder where monocloncal B cells predominantly found in peripheral blood

lymphocyte count >5

21
Q

CLL cel characteristics

A

slow growing
mature
low grade condition
carry normal B cell markers

22
Q

CLL risk factors

A

> 60yrs
male
white
FHx CLL

23
Q

CLL clinical features

A 
asymptomatic; incidental finding FBC
bone marrow failure: thrombocytopenia, anaemia
splenomegaly 
fever, sweats 
lymphadenopathy
24
Q

CLL indications for Rx

A 
progressive bone marrow failure 
lymphocyte doubling time <6mo
progressive splenomegaly 
massive lymphadenopathy 
systemic features
autoimmune cytopenias
25
Q

CLL binet staging A

A

<3 node ares

26
Q

CLL binet stage B

A

3+ node ares

27
Q

CLL binet stage C

A

3+ node areas

thrombocytopenia or anaemia

28
Q

CLL Rx

A

often nothing, watch + wait
cytotoxic chemo: fludarabine, bendamustine
monoclonal antibodies: rituximab
-novel agents: P13K inhibitor, BCL2 inhibitor

29
Q

CLL poor prognostic markers

A 
rapid lymphocyte doubling time 
advanced disease: Binet B, C 
atypical lymphocyte morphology 
loss/mutation P53
CD38+ expression
30
Q

lymphoma presentation

A 
lymphadenoapthy 
hepatosplenomegaly 
extranodal disease
B symptoms 
bone marrow involement
31
Q

staging of lymphoma: how it is done

A

lymph node biopsy
CT scan
bone marrow aspirate + trephine

32
Q

lymphoma stage 1

A

one nodal site involvement

33
Q

lymphoma stage 2

A

2 nodal sites involvement, either above or below diaphragm not both

34
Q

lymphoma stage 3

A

multiple nodal sites involvement above and below diaphragm

35
Q

lymphoma stage 4

A

extranodal disease e.g. liver, bone

36
Q

non-hodgkin lymphoma: how can it be classified

A

lineage: B cell or T cell
grade: high or low

37
Q

NH lymphoma low grade

A

indolent, often asymptomatic

responds to chemo but incurable

38
Q

NH lymphoma high grade

A

aggressive, fast growing

can be cured (combo chemotherapy)

39
Q

diffuse large B cell lymphoma

A

commonest subtype

high grade

40
Q

follicular lymphoma

A

low grade

often watch and wait

41
Q

lymphoma Rx

A

combination chemotherapy

  • anti-CD20 monoclonal antibody (rituximab)
  • chemo
42
Q

hodgkin lymphoma

A

B cells

characterised by presence hodgkin’s cells and reed-stenburg cells

43
Q

hodgkin lymphoma risk factors

A

EBV
glandular fever
geographical and familial clustering

44
Q

hodgkin lymphoma Rx

A

combination chemotherapy +/- radiotherapy
monoclonal antibodies (anti-CD30)
immunotherapy

45
Q

ALL bone marrow finding

A

> 20% bone marrow is progenitor cells

haematology (32 decks)

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