NHL, HL Flashcards
mature lymphoid malignancies
NHL
HL
Chronic Lymphocytic Leukemia
Multiple Myeloma
typically lymphomas don’t circulate in blood in significant numbers except
CLL
SLL
NHL
- cell of origin
- age
- lymphnodes
- BM
- tx (y/n)
- B cell (T/NK)
- 60-70 y/o
- any nodes
- often BM
- tx: yes
HL
- cell of origin
- age
- lymphnodes
- BM
- tx (y/n)
- B cell
- bimodal
- sequential
- often BM
- tx: yes
Chronic Lymphocytic Leukemia
- cell of origin
- age
- lymphnodes
- BM
- tx (y/n)
- B cell
- 60s-70s
- any nodes
- BM
- tx: yes
Multiple Myeloma
- cell of origin
- age
- lymphnodes
- BM
- tx (y/n)
- B cell
- 60s-70s
- Rarely nodes
- BM
- tx: yes
NHL epidemiology
- 5th leading cancer dx
- most comm hematological cancer
- 85% cells=B cell origin
- incidence more than doubled since 70s
NHL
presentation
local -swollen nodes -pain (compression/infiltration) -organ failure/compromise systemic -fevers, night sweats, weight loss, fatigue
indolent NHL
- follicular*
- marginal zone
- SLL
- lymphoplasmacytic lymphoma
aggressive NHL
- diffuse large B-cell*
- mantle cell
- peripheral t-cell lymphoma
- primary mediastinal large B-cell lymphoma
- anaplastic large cell lymphoma
- lymphoblastic lymphoma
- Burkitt’s
T cell surface antigens
CD2
CD3
CD4
CD8
B cell surface antigens
CD19
CD20
CD22
CD79a
NHL staging
I-single lymph node
II-2+ nodes, same side of diaphragm
III- 2+ nodes, different sides of diaphragm
IV- extra nodal disease (BM)
international prognostic index (for Non-Hodgkin’s lymphoma)
1 pt for each risk factor:
age performance status LDH extranodal sites Stage
NHL that initially responds to chemo, but ultimately recurs (not cured)
indolent
NHL with potentially profound response to chemo, ultimately curable
aggressive
NHL tx
- surgery has NO significant role
- radiation
- chemo
classes of chemo generally used in NHL
alkylators
anthracylines
steroids
indolent NHL tx
QOL tx
rituximab
rituximab
monoclonal CD20 Ab
antibody-dependent cellular cytotoxicity (ADCC)
complement-dependent cytotoxicity (CDC)
apoptosis
NHL chemo combo
CHOP
cyclophosphamide
doxorubicin
vincristine
prednisone
HIV-associated lymphoma
vast majority=aggressive
- B cell origin
- CD4 <200
- high viral load/advanced disease
- tx w/ HAART –> dec risk
HL
unusual variant of B-cell lymphoma (~15%)
adenopathy (progressive)
- neck/mediatinum
- sx: night sweats/fevers/weight loss, “pel-ebstein” fevers, pruritus, EtOH
- typically slow, orderly growth
- tx outcomes for early stage disease = excellent
HL age distribution
bimodal, 20s or 60s
nivolumab
targets PD-1 on T-cells (a suppressor of immune function)
binds and INactivates this
unleashes T cells that recognize Reed-Sternberg cells
HL tx
half of HL cases contain ____ DNA in Reed-Sternberg cells
EBV
reed sterberg cellClas
multinucleate giant cells derived from malignant B lymphocytes
CD30, CD15
IgH rearrangement
monoclonal
seen in classical HL (from mature B cells at germinal center)
CD30, CD15
Reed Sternberg cell
HL staging
I-single lymphoid chain
II-2 chains on one side of diaphragm
III-above and below diaphragm
IV-diffuse non-lymphoid spread
also
A-absense of constitutional sx
B-presence of (F/NS/>10%weight loss)
M-bulky mediastinal mass
E-involvement of extra nodal site
classical HL
4 subtypes
- nodular sclerosis
- mixed cellularity
- lymphocyte rich
- lymphocyte poor
non-classic HL
1 subtypes
HL tx goals
aimed at cute, start ASAP
HL
standard chemotherapy
ABVD
adriamycin
bleomycin
vinblastin
dacarbizine
HL early stage tx
radiation alone
chemo +radiation just to site of involvement
or chemo alone
surveillance of HL survivors
- mammograms starting at 30 or 8-10 yrs from XRT
- colonoscopy 8-10 yrs post XRT
Brentuximab
fusion chemo-immunoconjugate combining a monoclonal Ab against CD30 and an MT inhibitor
*RS cells =CD30
