Non Hodgkin's Lymphoma Flashcards
Define Non Hodgkin’s Lymphomas
These are a large group of lymphoid tumours, most commonly of B- cell origin
These are a large group of lymphoid tumours, most commonly of B- cell origin
Non Hodgkin’s Lymphoma
How are Non Hodgkin’s Lymphomas characterized
By an irregular pattern of spread
What is the incidence of Non Hodgkin’s Lymphoma
17 in 100,000
In a list of most common malignancies where does Non Hodgkin’s Lymphoma lie
5th
What is the aetiology of Non Hodgkin’s lymphoma
Unknown (although infectious agents are an important cause in particular subtypes)
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
What are the two subdivisions of Non Hodgkin’s lymphoma
Low grade
High grade
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
What are the constitutional symptoms of Non Hodgkin’s lymphoma
Fever
Night sweats
Weight loss
(Occurs less frequently than in Hodgkin’s disease)
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
What are the presenting features of Non Hodgkin’s lymphoma
Anemia
Neutropenia with infections
Thrombocytopenia with purpura
What is the investigative method for Non Hodgkin’s lymphoma
Lymph node biopsy
What confirms clonality in B-cell lymphomas
Expression of either κ or λ light chains confirms clonality
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
Deficiency in which line of blood cells is seen in advanced non-Hodgkin’s disease
Neutropenia thrombocytopenia or leucoerythroblastic features
Is LDH elevated in Non Hodgkin’s lymphoma
Yes
The various subtypes of NHL are associated with what
Characteristic Chromosomal Translocations
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) )
What is the Chromosomal Translocation in Burkitt’s Lymphoma
t (8;14)
t (8;14) translocation is which Non Hodgkin’s lymphoma
Burkitt’s
t (14;18) translocation is which Non Hodgkin’s lymphoma
Follicular Lymphoma
t (11;14) translocation is which Non Hodgkin’s lymphoma
Mantle Cell Lymphoma
t (2;5) translocation is which Non Hodgkin’s lymphoma
Anaplastic large cell lymphoma
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
