Non- Hodgkin's Lymphoma Flashcards
What is Non- Hodgkin’s Lymphoma?
- Lymphoma which does not have Reed- Sternberg cells
How does Non-Hodgkin’s Lymphoma affect the body?
- Lymphoma means that your WBC divide abnormally
- The cells start to divide before they are fully mature
- This means the cells are unable to fight infection
- The abnormal WBC collect in lymph nodes, bone marrow and spleen
Where does non- Hodgkin’s Lymphoma occur in the body?
- NHL starts in the lymph nodes
- It is commonly found in the neck, liver and spleen
- It can be found in the stomach, small bowel, bones, brains, testicles, skin and eye
What are the two types of NHL?
- B-cell Lymphoma
- T- cell Lymphoma
How common is NHL?
- 4 out of 100 cancers diagnosed are NHL
- 6th most common type of cancer in adults
Who get NHL?
- Common in older people
- 75 and over
What are the symptoms of NHL?
- Painless Swellings in neck, armpit and groin
- B symptoms
- enlarged tonsils
- lump in your tummy (enlarged spleen/ liver)
- breathlessness (lymphoma affecting nodes in your chest
What are the symptoms of NHL in the bone marrow?
- Anaemia, tiredness and breathlessness ( low RBC)
- infections (low WBC)
- bleeding problems, heavy periods and nosebleeds ( low platelets)
What are the symptoms of Lymphoma in the brain?
- Headaches
- Difficulty thinking
- Changes in Personality
- Epileptic fits (seizures)
- Confusion
- Coma
What are the risks of Non- Hodgkin Lymphoma?
- Age ( typically 75 and over)
- Weakened immune system ( HIV/AIDS/ anaemia/ SLE/ Sjogren’s Syndrome)
- Infections ( H-pylori/ HIV/ T cell lymphoma virus 1/ EBV/ Hepatitis)
- Family History of NHL
- Previous cancer and treatment
- Coeliac Disease ( enteropathy- associated T-cell Lymphoma)
- Breast Implant Associated Anaplastic Large Cell Lymphoma
What are the different types of NHL?
- Diffuse Large B cell Lymphoma
- Follicular Lymphoma
- Burkitt’s Lymphoma
What is Diffuse Large B cell Lymphoma and how does it present?
- Accounts for around 30% of NHL
- Presents with rapidly enlarging mass - neck, abdo, mediastinum
- disease may lead to SVCO
What is Follicular Lymphoma?
- 2nd most common NHL
- Presents with gradually worsening painless lymphadenopathy
What is Burkitt’s Lymphoma?
- high grade, rapidly proliferating
- B-cell NHL commonly affects children
What is the staging for Non-hodgkin’s Lymphoma?
- It is the same as Hodgkin’s Lymphoma
- Lugano classification
What are the low grade Non-Hodgkin Lymphoma?
- Follicular Lymphoma
- Mantle cell Lymphoma
- Marginal Zone Lymphoma (MALT lymphoma, Nodal Marginal Zone Lymphoma, Splenic marginal zone lymphoma)
- Small Lymphocytic Lymphoma ( also known as CLL)
- Lymphoplasmacytic Lymphoma (Waldenstrom’s macroglobulinaemia)
- Skin Lymphoma ( cutaneous B cell/ T cell lymphoma)
What are the high grade Non- Hodgkin’s Lymphoma?
- Diffuse large B cell Lymphoma
- Burkitt Lymphoma
- Peripheral T cell Lymphoma
- Lymphoblastic lymphoma
- Blastic NK cell lymphoma
- Enteropathy associated T cell lymphoma
What are the symptoms of Primary Cutaneous Lymphoma?
- Rashes
- Plaques
- Ulcers
- Mycosis fungoides (cutaneous T-cell Lymphoma)
What are the symptoms of Primary GI tract Lymphoma?
- Abdominal Pain
- Nausea
- Obstruction
- Haemorrhage
What is the gold standard investigation for Non-Hodgkin’s Lymphoma?
- Excision biopsy
What bloods are required for Non-Hodgkin’s Lymphoma?
- FBC
- U+E
- LFTs
- ESR
- LDH
- Uric Acid
- HIV, Hep B, Hep C
What imaging is required for Non-Hodgkin Lymphoma?
- Chest X-ray
- CT neck, abdomen, chest and pelvis (to identify enlarged lymph nodes)
- PET CT (staging and assessment of treatment response to lymphomas)
- MRI brain (particularly with leptomeningeal infiltration/ mass lesions are suspected)
- Testicular USS (identify testicular lymphoma)
- Bone Scan
What additional investigations are required?
- Bone marrow aspirate and biopsy
- Lumbar Puncture ( in patients with suspected CNS disease)
- FISH
What is the chemotherapy regime for Non-Hodgkin’s Lymphoma?
R-CHOP
- Rituximab ( monoclonal antibody against CD20 - which is found on B cells)
- Cyclophosphamide ( an alkylating agent which inhibits DNA synthesis through cross linking DNA)
- Doxorubicin (inhibits topoisomerase II)
- Vincristine (inhibits microtubule formation by binding to tubulin)
- Prednisolone (glucocorticoid steroid)
What immunotherapy treatment would you have for Non-hodgkin’s Lymphoma?
- CAR T-Cell Therapy
- T cells are taken from your blood (apheresis)
- The T cells are genetically changed so they are able to recognise + target specific proteins on the cancer cells
- These changed T cells can grow and multiply in the lab
- You receive a dose of chemotherapy which lowers your number of T cells and prepares your body for CAR T-cells
- Once there are enough cells you have a drip containing these cells back into your bloodstream
- CAR T-cells can then recognise and attack the cancer cells
What are the side effects of the Immunotherapy?
- Allergic reaction
- Cytokine- release syndrome
- Side effects affecting the brain
- Increased risk of infection
- Tumour Lysis Syndrome
What is Cytokine- Release syndrome?
- cytokines are a group of proteins that play an important role in boosting the immune system
- CAR T-cell therapy stimulates the immune system into making large amounts of cytokines
- Symptoms: Fever, Dizziness due to low BP, Difficulty breathing
What is the reversible treatment for cytokine release syndrome?
- Tocilizumab
What are CAR T-Cells designed to recognise?
- CD-19 protein/ antigen which is found on the surface of most B cells
