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Pathology ICSM COPY > Haematology 12 - Lymphoma 2 > Flashcards

Haematology 12 - Lymphoma 2 Flashcards

(45 cards)

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1
Q

What is the age distribution of Hodgkin’s lymphoma?

A

bimodal: 20-29yo (most common), >60yo (smaller peak)

M>F (ex nodular sclerosing)

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2
Q

Which subtype of Hodgkin lymphoma is more common in females

A

sclerosing sub-type

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3
Q

In what age group is nodular lymphocyte predominant HL common?

A

elderly - disorder of multiple recurrence

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4
Q

How do Reed Sternberg cells appear on the blood film?

A

Giant cell surrounded by reactive eosinophils

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5
Q

Subtypes of classial HL

A

Nodular sclerosing 80% - Good prognosis

Mixed cellularity 17% - Good prognosis

Lymphocyte rich (rare) - Good prognosis

Lymphocyte depleted (rare) - Poor Prognosis

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6
Q

What are the symptoms of Hodgkin’s lymphoma?

A

Painless lymphadenopathy, that becomes painful on drinking alcohol
Constitutional B symptoms
If advanced lymphadenopathy, may –> obstructive symptoms

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7
Q

Which investigation is used to diagnose hodgkin’s lymphoma, and which diagnosis is used for staging?

A

Diagnosis: LN biopsy
Staging: FDG-PET

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8
Q

Recall the different stages of Hodgkin’s lymphoma

A

I: one group of nodes
II: >1 group of nodes, same side of the diaphragm
III: Nodes on both sides of the diaphragm
IV: extranodal spread
Then:
A: no B symptoms
B: one/ any of fever/ weight loss/ night sweats

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9
Q

What type of chemotherapy is used in Hodgkin’s lymphoma?

A

ABVD

Adriamycin

Bleomycin

Vinblastine

DTIC (Dacarbazine)

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10
Q

long term consequences of combo chemo in HL

A

pulmonary fibrosis

cardiomyopathy

but preserves fertility unlike MOPP

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11
Q

After how many cycles of chemotherapy for Hodgkin’s lymphoma should the FDG-PET be repeated to check response?

A

2

Also at the end to ? need for additional chemo

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12
Q

What is the risk of giving radiotherapy for Hodgkin’s lymphoma?

A

It produces a lot of collateral damage, and when given alongside chemotherapy increases the risk of secondary malignany significantly

breast, leukaemia, lung/skin

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13
Q

What is the prognosis like in HOdgkin’s lymphoma?

A

worse in older pts and lymphocyte depleted histology

lower stages do better

10% die from treatment complications (secondary malignancy/CVS event)

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14
Q

Recall 4 prognostic markers in lymphoma

A
  1. LDH
  2. Performance status
  3. HIV serology
  4. Hep B serology
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15
Q

How does histology predict lymphoma clinical course?

A

more aggressive = faster symptom progression = more treatable

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16
Q

How aggressive is diffuse large B cell non-Hodgkin’s lymphoma?

A

High grade

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17
Q

How is diffuse large B cell non-Hodgkin’s lymphoma treated?

A

6-8 cycles of R(Rituximab)-CHOP

  • Rituximab (anti-CD20)

Combination chemotherapy:

  • Cyclophosphamide C
  • Adriamycin (H)
  • Vincristine (O)
  • Prednisolone P

Relapse -> autologous SCT

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18
Q

What is diffuse large B cell NHL determined by?

A

IPI

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19
Q

How aggressive is follicular non-Hodgkin’s lymphoma?

20
Q

What is prognosis and treatment of follicular NHL determined by

Study These Flashcards
A

FLIPI score (a modified version of IPI)

21
Q

HOw would you manage follicular NHL?

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A

watch and wait - only treat if clinically indicated

  • extranodal compression - bowel/bile duct/ureter/vena cava
  • massive painful nodes
  • recurrent infections

RCHOP/RCOP - not curative

22
Q

What mutation is commonly associated with follicular non-Hodgkin’s lymphoma?

Study These Flashcards
A

t(14;18)
Translocation of Bcl2 –> oncogene

23
Q

Which subtype of non-Hodgkin’s lymphoma is associated with chronic H. pylori?

Study These Flashcards
A

Extra-nodal marginal zone lymphoma

gastric MALToma (MZL)

24
Q

What are the symptoms of extra-nodal marginal zone lymphoma?

Study These Flashcards
A

Epigastric pain, ulceration and bleeding

25
Which lymphoma subtype does Psittaci infection lead to?
lacrimal gland extra nodal MZL
26
How aggressive is enteropathy-associated non-hodgkin's lymphoma?
Very aggressive
27
EATL involves which part of body and which cells?
mature T cells small intestine - jejunum and ileum
28
What is the main association of enteropathy-associated non-hodgkin's lymphoma?
Coeliac
29
Management of EATL
poor response to chemo (BREAKS RULE - aggressive but unresponsive to chemo) prevention - strict gluten free diet
30
What is CLL
Proliferation of mature B cells
31
What finding would you see on FBC in CLL?
Lymphocytosis (5-300 x 10^9/L) Normocytic normochromic anaemia Thrombocytopaenia NOTE: as this is an indolent leukaemia, it is often only picked up during routine blood tests for other reasons
32
What finding on a blood film is typial of CLL?
Smear/ smudge cells - weak cells that break when put on slide Bone marrow lymphocytic replacement of normal marrow elements
33
Which antigens do mature B cells express?
slg and CD19
34
Recall the surface markers of intermediate B cells vs mature B cells vs CLL mature B cells
Intermediate B cell: CD5 positive Mature B cell: CD19 positive, CD5 negative Mature CLL B cell: CD5 positive and CD19 positive CD% - normally in intermediate B cell only present in BM - in CLL this is seen in the peripheral blood
35
Recall the surface markers of normal mature T cells
CD19 NEGATIVE CD5 POSITIVE CD3 positive CD4 or CD8 positive
36
What are the 2 staging methods that can be used in CLL?
Rai staging Binet staging
37
How can pre- and post-germinal centre CLL be differentiated?
VDJ sequencing
38
Which mutation is associated with a particularly poor prognosis in CLL?
17p deletion (TP53) - no response to chemo
39
What are 3 prognostic indicators for CLL?
IgH V mutation status - worse prognosis in unmutated (pre germinal centre) than mutated - somatic hypermutation (post germinal centre) CLL FISH cytogenetic panel TP53 mutation status - worse prognosis in mutated
40
Why is there an increased risk of infection in CLL?
high lymphocytes → but are monoclonal so not useful for Ab production abundance of non functional B cells → hypogammaglobulinaemia as normal B cells become suppressed
41
Why is there BM failure in CLL?
BM effacement → healthy BM suppressed
42
What is Richter's syndrome?
Rare transformation of CLL to high grade lymphoma
43
Recall 3 classes of targeted therapy that can be given to treat CLL
1. BCR kinase inhibitors (eg ibrutinib and idelalisib) 2. BCL2 inhibitors (eg venetoclax) 3. CAR-T and other experimental cell-based therapies relapse -\> ASCT
44
What chemotherapeutic agents used to be given in CLL?
rituximab
45
HOw does BCL 2 inhibitor work in lymphoma treatment?
permits apoptosis CLL cells good response in high risk p53 mutated main risk → tumour lysis syndrom

Pathology ICSM COPY (90 decks)

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