Lymphoid Malignancies Flashcards

1
Q

Most common lymphoid malignancies?

A
NHL (high grade)
NHL (low grade)
Hodgkin's lymphoma
CLL
ALL 
MM
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2
Q

What’s the most common high and low grade NHLs?

A

High grade = Diffuse Large B Cell Lymphoma

Low Grade = Follicular Lymphoma

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3
Q

How would you expect to see a lymphoma?

A

Lymphadenopathy & Hepatosplenomegaly

Can also have extranodal disease, bone marrow involvement and B symptoms (Fever, night sweats & weight loss)

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4
Q

What tests would you do on a suspected Lymphoma?

A

Biopsy the node
Aspirate bone marrow
CT scan

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5
Q

What’s the difference between high and low grade NH lymphomas?

A

Low grade = often asymptomatic, not curable but treatable

High grade = Aggressive & fast growing, needs combo-chemo but curable

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6
Q

What treatment is used for NH lymphomas?

A

Combination Chemo (Anti-CD20 monoclonal Abs + Chemo)

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7
Q

Who gets Hodgkin’s LYmphoma?

A

It peaks at 15-35yrs then later in life (2nd peak ass with EBV)

More often men.

familial risk and geographical clustering suggest a genetic pattern

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8
Q

How would you treat a Hodgkin’s Lymphoma?

A

Combination Chemo (ABVD)
+/- RT
Anti-CD30 MAB
Immunotherapy

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9
Q

What would a patient with CLL look like?

A

Often asymptomatic but when they get problems:

  • progressive Bone marrow failure
  • Lymphadenopathy
  • ~ Splenomegaly, fever & sweats
  • Less often hepatomegaly, infections & weight loss

Also immune paresis (no immunoglobulin production)
And Autoimmune Haemolytic Anaemia or ITP

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10
Q

How would you stage a CLL patient?

A

Binet Staging:
A - some nodes
B - more nodes
C - other symptoms or autoimmune

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11
Q

When would you treat someone with CLL?

A

Only if there’s signs that it’s worsening:

  • Progressive marrow failure
  • Massive lymphadenopathy
  • Progressive Splenomegaly
  • Lymphocyte doubling time <6months
  • Systemic Symptoms
  • Autoimmune Cytopenias
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12
Q

How do we treat a case of CLL?

A

Often just watch and wait. If it’s stable they may be better off without treatment

Cytotoxic Chemo e.g. Fludarabine
Monoclonal Abs e.g. Rituximab
Tyrosine Kinase Inhibitors e.g. Ibrutinib

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13
Q

What factors would indicate a poor prognosis for CLL?

A
  • Stage B & C
  • Atypical lymphocyte morphology
  • Rapid lymphocyte doubling time (<12month)
  • Loss/mutation of p53
  • CD38+ expression
  • Unmutated IgVH gene
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14
Q

What is required to diagnose cLL?

A

1) Blood >5x10^9/L lymphocytes
2) Bone Marrow >30% lymphocytes
3) Characteristic Immunophenotyping

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15
Q

Who gets ALL?

A

75% are in kids <6

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16
Q

how does ALL present?

A

Acute (2-3wks) h/o:

  • Bone Marrow Failure (Anaemia, bleeds & infections)
  • Bone/joint pain
  • Infections
  • Sweats
17
Q

What do we need to diagnose ALL?

A

Do a FBC to show low haemonoglobin, low platelets, low neutrophils and high WCC

Confirm with a Marrow biopsy showing >20% lymphoblasts

18
Q

What can we then treat ALL with?

A

Multiagent Intensive chemo (Induction, Consolidation & Maintenance)

Allogenic stem cell transplant

There are new T cell immunotherapies

19
Q

Poor prognostic factors for aLL?

A
Older
Higher WCC
Immunophenotype
Certain genetics
Slow/poor response to treatment
20
Q

What are the main T cell immunotherapies for ALL?

A

BiTe molecules (Bispecific T cell engagers)

CAR T cells (Chimeric Antigen Receptor T Cells)

21
Q

Potential side effects of ALL T-cell immunotherapies?

A

Cytokine Release Syndrome i.e. fever, hypotension & SOB

Neurotoxicity - Confusion with normal conscious level, seizures, headache, focal neurology & coma

22
Q

Prognosis for ALL?

A

Adults have a roughly 50% cure rate

Kids more like 90%