Non Hodgkin's Lymphoma Flashcards by Shadekiel Kassie

Define Non Hodgkin’s Lymphomas

These are a large group of lymphoid tumours, most commonly of B- cell origin

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These are a large group of lymphoid tumours, most commonly of B- cell origin

Non Hodgkin’s Lymphoma

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How are Non Hodgkin’s Lymphomas characterized

By an irregular pattern of spread

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What is the incidence of Non Hodgkin’s Lymphoma

17 in 100,000

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In a list of most common malignancies where does Non Hodgkin’s Lymphoma lie

5th

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What is the aetiology of Non Hodgkin’s lymphoma

Unknown (although infectious agents are an important cause in particular subtypes)

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What are the three differences between Low and High grade non-Hodgkin’s Lymphoma

Low Grade

indolent
respond well to chemotherapy
difficult to cure

High Grade

aggressive + need urgent treatment
curable

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What are the two subdivisions of Non Hodgkin’s lymphoma

Low grade

High grade

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What are six clinical features of non- Hodgkin’s lymphomas

1] Superficial Lymphadenopathy 
2] Constitutional symptoms 
3] Oropharyngeal involvement
4] Presenting Features (Anemia etc)
5] Abdominal Disease
6] involvement in other organs

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What are the constitutional symptoms of Non Hodgkin’s lymphoma

Fever
Night sweats
Weight loss
(Occurs less frequently than in Hodgkin’s disease)

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Describe the Oropharyngeal involvement of Non Hodgkin’s Lymphoma

Disease of the Oropharyngeal lymphoid structures (Waldeyer’s ring) which may cause complaints of sore throat or noisy or obstructed breathing

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What are the presenting features of Non Hodgkin’s lymphoma

Anemia
Neutropenia with infections
Thrombocytopenia with purpura

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What is the investigative method for Non Hodgkin’s lymphoma

Lymph node biopsy

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What confirms clonality in B-cell lymphomas

Expression of either κ or λ light chains confirms clonality

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What is type of anemia is observed in non-Hodgkin’s Lymphoma

Normochromic or normocytic anemia is usual but hemolytic anemia and then also occur

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Deficiency in which line of blood cells is seen in advanced non-Hodgkin’s disease

Neutropenia thrombocytopenia or leucoerythroblastic features

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Is LDH elevated in Non Hodgkin’s lymphoma

Yes

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The various subtypes of NHL are associated with what

Characteristic Chromosomal Translocations

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What are the four types of Non Hodgkin’s lymphoma

Burkitt’s lymphoma ( t(8;14) )
Follicular Lymphoma ( t(14;18) )
Mantle Cell Lymphoma ( t(11;14) )
Anaplastic large cell lymphoma ( t(2;5) )

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What is the Chromosomal Translocation in Burkitt’s Lymphoma

t (8;14)

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t (8;14) translocation is which Non Hodgkin’s lymphoma

Burkitt’s

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t (14;18) translocation is which Non Hodgkin’s lymphoma

Follicular Lymphoma

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t (11;14) translocation is which Non Hodgkin’s lymphoma

Mantle Cell Lymphoma

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t (2;5) translocation is which Non Hodgkin’s lymphoma

Anaplastic large cell lymphoma

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What is the Chromosomal Translocation in Follicular Lymphoma

t(14;18)

What is the Chromosomal Translocation in Mantle Cell Lymphoma

t (11;14)

What is the Chromosomal Translocation in Anaplastic large cell lymphoma

t (2;5)

What is the main difference between T cells and B cells lymphoma

In B-cell Lymphomas the IMMUNOGLOBULIN GENES are clonally rearranged While in T-cell Lymphomas the there is clinal rearrangement of the T-CELL RECEPTOR GENES

Staging procedures for Non Hodgkin’s lymphoma usually include

``` Chest X-Ray Computed Tomography (CT) scanning Magnetic Resonance Imaging Bone Marrow Aspiration Trephine Biopsy ```

Which method/procedure may detect disease not seen on CT Scan

PET

What is most commonly used in initial staging of Non Hodgkin’s lymphoma

Combined PET-CT

What is the most common form of Non Hodgkin’s lymphoma

``` Follicular Lymphoma (low grade) t (14;18) ```

What is the likely age of patients with Follicular lymphoma

Middle aged or elderly

What is the median survival for Follicular lymphoma

10yrs

What is the presentation of Follicular lymphoma

Painless lymphadenopathy (often widespread) Majority have stage III and IV disease

Which drugs are used in initial treatment for Follicular lymphoma

Chlorambucil Cyclophosphamide Vincristine Prednisolone ((CVP)) Achieves a response in up to 90% of pts

How is Follicular lymphoma disease relapse treated

Treated with similar chemotherapy regimen’s but the disease becomes increasingly difficult to control and more intensive chemotherapy and radiolabeled antibody therapy may be considered Autologous stem cell transplantation may be valuable in patients with a history of at least one relapse

List five subtypes of low grade non-Hodgkin’s lymphoma

``` Follicular lymphoma Lymphocytic lymphoma Lymphoplasmacytoid lymphoma Mantle cell lymphoma Marginal zone lymphoma ```

Which lymphoma appears to be the tissue phase of chronic lymphocytic leukemia

Lymphocytic lymphoma

Lymphocytic lymphoma appears to be the tissue phase of which disease

Chronic lymphocytic leukemia CLL

What is the treatment for Lymphoplasmacytoid lymphomas

Chlorambucil Fludarabine Monoclonal antibodies

Define Mantle Cell Lymphoma

Derived from pre germinal centre cells localized in the primary follicles or in the mantle region of secondary follicles

What is the clinical presentation of Mantle Cell Lymphoma

Lymphadenopathy | Bone marrow infiltration and tumour cells in the blood

Does Mantle Cell Lymphoma is characterized by good or poor prognosis

Poor

What are the current treatment regimens for Mantle Cell Lymphoma

``` CVP Chlorambucil Cyclophosphamide Vincristine Prednisolone ``` ``` CHOP Cyclophosphamide Hydroxodaunorubicin Oncovin Prednisolone ``` Autologous stem cell transplantation is being investigated

What is the prognosis for Mantle Cell Lymphoma

Poor | Median survival 3yrs

Describe marginal zone lymphomas

Extranodal | Localized

What type of Non Hodgkin’s lymphoma is MALT (mucosa associted Lymphoid tissue)

Marginal zone lymphomas

What is the cause of MALT (mucosa associted Lymphoid tissue)

Pre existing inflammatory or autoimmune disorder

What is the most commonform of MALT (mucosa associted Lymphoid tissue)

Gastric MALT lymphoma

Gastric MALT Lymphoma is preceded by what

Helicobacter (H.) pylori infection

How is MALT Lymphoma treated (in early stages)

Antiobiotic therapy aimed at eliminating H pylori

List three types of High gradeNon Hodgkin’s lymphoma

Lymphoblastic Lymphoma Burkitt’s Lymphoma Diffuse large B-cell lymphoma (DLCL)

Define Diffuse large B-cell lymphomas

A heterogeneous group of disorders representing the classical ‘high-grade’ lymphomas

What is the clinical presentation of Diffuse large B-cell lymphomas

Rapidly progressive lymphadenopathy Fast rate of cellular proliferation Progressive infiltration may affect the bone marrow, GIT, spinal cord, kidneys

The cell of origin of DLCL has been of prognostic significance, Which is more favorable: germinal centre or activated peripheral B cell

Germinal centre

What is the treatment for DLCL Diffuse Large B-cell lymphomas

``` R-CHOP Rituximab Cyclophosphamide Hydroxodaunorubicin Oncovin Prednisolone ``` Given 2-,3- or 4- weekly cycles for 6-8 courses

What is the treatment for DLCL Diffuse Large B-cell lymphomas with relapse and chemotherapy sensitive disease

High dose chemotherapy with IFOSAMIDE, EPIRUBICIN and EPTOPOSIDE (IVE)

What is Burkitt’s Lymphoma

The lymphomatous correlate of L3 acute lymphoblastic leukemia

Endemic (African) Burkitt’s Lymphoma is seen in areas with exposure to which disease

Malaria | EBV

What is the clinical presentations for Burkitt’s Lymphoma

Lymphadenopathy of thejaw

Define T-cell Lymphomas

Peripheral T cell lymphomas that present with lymphadenopathy rather than extranodal disease are a heterogeneous group of rare tumours of CD4+ phenotype

What are the seven variants of T cell lymphomas that are recognized

Peripheral T-cell Non Hodgkin’s lymphoma Angioimmunoblastic lymphadenopathy Mycosis fungoides Sézary Syndrome Adult T-cell leukemia Angiocentric Lymphomas Anaplastic large cell lymphoma

Define Peripheral Tcell non Hodgkin’s lymphoma

These derive from post-thymic T cells at various stages of differentiation

How is Peripheral T-cell Non Hodgkin’s lymphoma treated

CHOP Cyclophosphamide Hydroxodaunorubicin Oncovin Prednisolone

Peripheral T-cell Non Hodgkin’s lymphoma treated prognosis

Poor