haematology - lymphoma Flashcards
(67 cards)
define lymphoma
neoplastic tumour of lymphoid tissue found in
- lymph nodes (often)
- other lymphoid tissue (sometimes)
- anywhere (rarely)
Hodgkin’s lymphoma
20% of lymphomas
M>F, 20-29 and >60yrs
spreads contiguously to adjacent lymph nodes
Hodgkin’s lymphoma is associated with
EBV
clinical presentation of Hodgkin’s lymphoma
asymmetrical painless lymphadenopathy
+/- obstructive/mass effect symptoms
FLAWS
mediastinal/cervical nodes
pain in affected nodes after alcohol
investigations for Hodgkin’s lymphoma
CT/PET
LN/BM biopsy (cells stain with CD15 and CD30)
blood film (Reed Sternberg cells)
Reed Sternberg cells
seen in Hodgkin’s lymphoma
bi-nucleate/multinucleate owl eyed mature lymphocytes
Staging system for Hodgkin’s Lymphoma
Ann Arbor
1: 1 LN region
2: 2+ LN regions on same side of diaphragm
3: 2+ LN regions on opposite sides of diaphragm
4: extra nodal sites
A = no constitutional symptoms
B = constitutional symptoms
treatment overview for Hodgkin’s lymphoma
combination chemotherapy
radiotherapy
intensive chemo and autologous SCT
combination chemotherapy for Hodgkin’s lymphoma
used in most cases
ABVD - adriamycin, bleomycin, vinblastine, and dacarbazine
stage 1/2 = 2-4 cycles
stage 3/4 = 6-8 cycles
radiotherapy for Hodgkin’s lymphoma
used in conjunction with chemo in bulky areas or limited disease
caution of radiotherapy for Hodgkin’s lymphoma
high risk of breast cancer in women
intensive chemotherapy for Hodgkin’s lymphoma and autologous SCT
for relapsed patients
prognosis of Hodgkin’s lymphoma
excellent especially if young and intensively treated
Where are stem cells harvested from for a transplant
peripheral blood
BM
umbilical cord blood
Collecting stem cells from peripheral blood requires
stimulation by G-CSF
SCTs
enables high dose chemo/radiotherapy to eradicate malignant cells at the cost of BM ablation
autologous SCTs
patient’s own SCs harvested, frozen, and reintroduced
autologous SCTs used in
multiple myeloma
lymphoma
benefits of autologous SCTs
no graft vs leukaemia effect
no GVHD
lower risk of infection
allogenic SCTs
HLA-matched donor SCs harvested and introduced to colonise ‘empty’ BM
risks associated with allogenic SCTs
GVHD
opportunistic infections
infertility
secondary malignancies
Non-Hodgkin’s Lymphoma
80% of lymphomas
classified according to:
- mature/immature
- histology
- B/T cell lineage
high grade non-Hodgkin’s lymphomas
very aggressive: Burkitt’s
aggressive: Diffuse large B cell, Mantle cell
low grade non-Hodgkin’s lymphomas
indolent - follicular, marginal zone, small lymphocytic
