Both HL and NHL start in the immune system, but spread differently. Which is generally more aggressive?
Hodgkins.
Which lymphoma is more common:
Less than 10 years old?
Between 15-19?
Males v females?
Overall 15% of childhood cancers
For children < 10 years of age, NHL is more common.
For children between the ages of 15-19, HD is almost twice as prevalent as NHL and is also very common in adults.
Male to female ratio
NHL < 15 years of age 3-4 times greater incidence in males compared to females
HD < 8 years of age male to female ratio is 4:1; by age 10 years and older the ration is 3:1 male to female.
Overall survival in HL and NHL?
HL - 90%, NLH similar depending on stage
General difference between B and T cells?
Both arise in marrow.
B cells become memory cells and regonize specific antigens. they attach and alert when the recognize one.
T cells either become helpers or killers
6 major places that are lymphoid tissues (other than lymph nodes)
- Tonsils and adenoids
- Thymus
- Spleen
- Small intestine (peyers patches)
- bone marrow
- skin
Which is typically diagnosed with the Reed-Sternberg cell?
Hodgkins. gian cell with ‘owls eye’. It can also pop up with mono so its important to note the node it came from and if it is a ‘reactive’ lymph node architecture if it generally diagnostic. This is why a needle biopsy is not the way to go, they need to biopsy the whole thing if HD is suspected.
Hodgkins is most likely derived from B lymphocytes and commonly stain postiive for what?
CD30 and Fascin
Hodgkin’s is sometimes associated with what infection?
EBV
Hodgkin’s is more prevalent in which gender/age?
Rarely less than 5, peaks in adolescents and more common in males
What are the 2 predominant subtypes of HL?
1) Classic
2) Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)
What do 80% of HL present with?
painless lymphadenopathy. Often supraclavicular or cervical.
In general, if somebody with HL presented with lymphadenopathy in THESE lymph nodes, it would indicate a serious pathologic process
epitrochlear (hollow above elbow) or supraclavicular
In staging HL, what is the difference between A symptoms and B symptoms
A is asymptomatic. B symtpoms include unexplained fevers, night sweats and weight loss.
How do you diagnose HL?
Biopsy lymph node. Remove the entire node.
Which scan is the gold standard for HL?
PET.
Would you get a bone scan for HL?
only if there is bony involvement.
What are the 4 stages of HL based on Ann Arbor Staging Classification
Stage I - disease confined to one lymph node or a single extralymphatic organ/site
Stage II - 2 or more lymph node regions on the same side of the diaphragm, or more than one organ/site and one or more lymph node regions on the same side of the diaphragm
Stage III - lymph nodes on both sides on diaphragm, possible involving spleen or organ/site
Stage IV - diffuce involvement of non-lymphoid organs or tissues (marrow, lung, liver, bone, etc)
What is favorable risk HL?
stage I, IIA, and non-bulky disease (mediastinal mass < 1/3 maximum chest diameter or non-mediastinal mass < 6 cm in diameter.)
Which HL treatments will get XRT? When?
Favorable patients only get it if they are ‘slow responders’ aka after 2 cycles of chemo have not shrunk initial mass by 80%. They will get more chemo and then low dose radiation therapy.
If unfavorable, 5 chemo cycles followed by either low dose rad therapy (IFRT) or radiotherapy.
How long is treatment for HL
about 7 months
Which medication for HL has food restrictions?
procarbazine.
What is a popular HL regimen?
There are many. ABVD has adria, bleo, vinblastine and dacarbazine
In XRT, what is the involved field, mantle field and inverted Y field?
Involved- original site
Mantle - neck check axillae
Inverted Y - spleen, para-aortic. common and eternal iliac and inguinal lymph nodes.
(see pic slide 27)
What should be considered for females getting pelvic XRT?
Oophoropexy, surgical relocation of ovaries to preserve fertility
What are risk factors for NHL? (immunodeficincies, either acquired or congenital)
-wiscott aldrich (eczema, thrombocytopenia, immune deficiency and bloody diarrhea)
-ataxia telengectasia
-primary immune deficiency
-X linked immune deficiencies
and anything acquired such as HIV, GVH, or a lympoproliferative disorder
What is one of the fastest growing human tumors?
NHL, many children have life threatening symptoms by the time they reach a diagnosis
Which scan is used if a PET is not available
Gallium (slide 44)
When a presenting patient needs to get a marrow and biopsy what should be considered regarding mediastinal mass?
May be contraindicated with general anesthesia depending on how close to airway. If marrow/CSF is positive then you can get away without doing a biopsy
What are the stages of the St Jude system for NHL?
Stage I - one tumor or single node area (except chest or abdomen)
Stage II - single tumor and regional nodes, greater than 2 nodes on same side of diaphragm or GI tumor
Stage III - 2 tumors on opposite sides of diaphragm, or greater than 2 nodal areas on both sides, primary chest/abdomen, or paraspinal/epidural tumor
Stage IV - any of the above plus CNS/marrow involvement
Most common treatment for NHL?
Chemo, multiple agents. T-cell lymphoma is alot like ALL treatment.
Radiation is usually not used unless CNS positive T cell, or palliation.
If refractory, transplant.
What are the 4 main types of NHL in childhood, and what is the origin?
Lymphoblastic lymphoma - t cell, about 30%, usually with mediastinal mass
Burkitt - B cell, often translocation C-MYC, often abdominal, or head/neck, often with abdominal pain or mimics appendicitis. assoc with ebv
Diffuse large B cell - B cell, CD antigens
Anaplastic large cell lymphoma (ALCL) - rare, T cells on CD 30
What is Burkitt ‘leukemia’
If patients have more than 25% blasts in marrow they technically have leukemia, so a rare subtype of ALL is burkitt leuk(mature B cell) which is meant to distinguish is from other ALL because it should NOT be treated as ALL (poor response) it should be treated like Burkitt lymphoma
