Non-Hodgkins Lymphoma

Question 1

Which cytogenetic abnormalities are present?

Answer 1

translocations involving the immunoglobulin genes in the B cell neoplasms

Question 2

What is the pathogenesis of NHL?

Answer 2

translocations of oncogenes to the immunoglobulin loci on chromosomes 2, 14 or 22 leading to over expression of the oncogene. This causes alteration of the cell cycle and leads to failure of apoptosis or aberrant expression of survival genes

Question 3

What are the clinical features?

Answer 3

• superficial lymphadenopathy (asymmetrical painless enlargement in one or more regions)
• constitutional symptoms ( fever, night sweats, weight loss)
• oropharyngeal involvement (5-10% of patients)
• anaemia symptoms
• infections (neutropenia)
• purpura (thrombocytopenia)
• abdominal disease
• other organs (skin, brain, testes, thyroid)

Question 4

Which tests are used for staging?

Answer 4

trephine biopsy, Chest x-ray and PET/CT

Question 5

What is used as a prognostic marker?

Answer 5

serum LDH (raised in rapidly proliferating and extensive disease)

Question 6

What is the Deauville criteria used for?

Answer 6

To determine whether a lymph node is normal or abnormal

Question 7

What is the first line treatment?

Answer 7

Chemo + monoclonal antibody against tumor cell

Question 8

Drugs that inhibit BCL-2 activity are also used to treat NHL. Give an example of this type of drug

Answer 8

Venetoclax

Question 9

Which monoclonal antibodies are given for B cell lymphomas?

Answer 9

antibodies against CD20 e.g. rituximab, ofatumumab, obinutuzumab

*“mabs” for monoclonal antibodies

Question 10

Which monoclonal antibody is used for anaplastic large cell lymphoma?

Answer 10

antibody against CD30 e.g. Brentuximab

Question 11

List the types of low grade NHL

Answer 11

small lymphocytic lymphoma
lymphoplasmacytoid lymphoma
marginal zone lymphoma
follicular lymphoma
mantle cell lymphoma

Question 12

small lymphocytic lymphoma is the tissue presentation and has the same treatment of which leukemia?

Answer 12

B-CLL

Question 13

What are the diagnostic features of lymphoplasmacytoid lymphoma?

Answer 13

• monoclonal serum IgM + BM or lymph node infiltration with lymphoplasmacytoid cels
• mutation of MYD88

Question 14

Which treatment is given for lymphoplasmacytoid lymphoma?

Answer 14

anti-CD20 antibody (rituximab) + chemo

Question 15

Which translocation is present in follicular lymphoma and what does this cause?

Answer 15

t(14;18)
- leads to constitutive expression of BCL2 gene which causes reduced apoptosis

Question 16

What are the molecular abnormalities in follicular lymphoma?

Answer 16

CD10, CD19, CD20, BCL2, BCL6 positive

Question 17

Which stage of follicular lymphoma has the worst prognosis?

Answer 17

3b

Question 18

Where are mantle cell lymphomas derived from?

Answer 18

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

Question 19

Which translocation is present in mantle cell lymphoma?

Answer 19

t(11;14)