Malignant Lymphomas

Question 1

What are the two types of malignant lymphomas

Answer 1

Hodgkin’s and Non Hodgkin’s Lymphoma

Question 2

List 8 aetiologic agents that can cause Malignant Lymphoma

Answer 2

Environmental agents(herbicides, wood dust, glues, fertilizers)

Genetic abnormalities

Inflammatory bowel disease

Autoimmune disorders

Lymphatoid papulosis

Immunodeficiency states

Viral Infections

Bacterial Infections

Question 3

Which bacterial infections can lead to development of malignant lymphoma

Answer 3

Helicobacter pylori

Campylobacter jejuni

Question 4

What age is most at risk with Non Hodgkin’s lymphoma

Answer 4

Increases with age

Question 5

Which gender is more prone to Non Hodgkin’s Lymphoma

Answer 5

Male

Question 6

List 7 clinical features of Non Hodgkin’s lymphoma

Answer 6

Painless lymph node enlargement
Hepatosplenomegaly
GI symptoms
Features related to disease at extranodal sites
Constitutional symptoms- fever, night sweats, weight loss
Cytopaenias
Metabolic Derangements

Question 7

What tests are used to diagnose Non Hodgkin’s lymohoma

Answer 7

Tissue biopsy
Functional imaging (PET) scan

Question 8

What investigations are done when testing for Non Hodgkin’s lymphoma

Answer 8

History and physical exam
CBC 
Serum chemistry 
Radiology 
BM aspirate and biopsy
Lumbar Puncture with CSF in selected cases
GI endoscopy 
Cytology of third space fluids
Selected additional radiology
Lymph Node Biopsy
Molecular Markers
Cytogenetic

Question 9

What are five classification of prognosis factors for Non Hodgkin’s lymphoma

Answer 9

Molecular profiling using gene expression
International Prognostic Index (IPI) for aggressive NHL/ FLIPI Score (follicular Lymphomas)
Biology
Laboratory
Clinical

Question 10

What clinical factors are used for prognosis of NHL

Answer 10

Stage 
Age
Performance status
B symptoms 
Mass size
Number of extra nodal sites 
BM involvement 
Time to Complete Remission (CR)

Question 11

What are the characteristics for International Prognostic Index (IPI) for aggressive NHL

Answer 11

Age > 60
Stage (III or IV)
LDH - elevated 
No of extranodal status (2-4)
Performance status (2-4)
Max score of 5

Question 12

What are the characteristics for International Prognostic Index (IPI) for aggressive NHL

Answer 12

Age
Stage
>4 LN groups involved
LDH
Performance Status
Hb <12gm/dl

Question 13

What is the classification of Low Grade Lymphoma

Answer 13

Small lymphocytic Lymphoma
Follicular small cleaved cell
Follicular mixed lymphoma

Question 14

How is Low grade lymphoma treated

Answer 14

Chemotherapy
Monoclonal Ab
Maintenance therapy

Question 15

How is Intermediate grade lymphoma treated

Answer 15

Chemotherapy +/- monoclonal Ab therapy if indicated

Combined modality therapy (never Radiotherapy alone)

Question 16

What is the treatment given for High grade lymphoma

Answer 16

Combination therapy

Question 17

What is the treatment for Relapsed NHL

Answer 17

Autologous stem cell transplantation in pts with chemo sensitive disease

Question 18

List 9 Special Lymphomas

Answer 18

ATLL- Adult T cell Leukemia/Lymphoma 
HTLVI associated 
Peripheral T cell NHL
Lymphadenopathy 
Hepatosplenomegaly
Lytic bone lesions
Leukemia 
Cutaneous Lymphoma 
Hypercalcaemia

Question 19

List five types of ATLL (Adult T cell Leukemia/Lymphoma)

Answer 19

Smouldering
Chronic
Lymphoma 
Acute
Defined by LDH level

Question 20

What is the pathogenesis of Non Hodgkin’s lymphoma

Answer 20

HTLV1 (human T cell leukemia virus type 1)

Mother to child - breastfeeding
(IV drug use)
(Male to female )

Question 21

What is the general treatment for Non Hodgkin’s lymphoma

Answer 21

Correct hypercalcemia
Allopurinol to avoid hyperuricaemia
Manage infections

Question 22

Which cell is involved in Lymphoblastic Lymphoma

Answer 22

T cell

Question 23

How is lymphoblastic lymphoma treated

Answer 23

Prophylactic treatment for CNS

Treated as ALL

Question 24

Which cell is involved in HIV associated NHL

Answer 24

B cell