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Year 3: Haematology > Hodgkin's Lymphoma > Flashcards

Hodgkin's Lymphoma Flashcards

1
Q

Describe the pathway of where normal B lymphocyte development occurs [4]

A

B cells:
- Bone marrow
- Blood (as niave B-lymphocytes)
- Lymphoid tissue (e.g. spleen / LNs / liver); devell
- (back to the) Bone Marrow and become plasma cells

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2
Q

Describe the process of normal T cell development [4]

A
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3
Q

Through which process do T lymphocytes make new TCR for antigens [1]

A

T cells actively mutate their DNA via VDJ recombination to make a unique T cell receptor for new antigens as immature T cells

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4
Q

Describe the process of somatic hypermutation [2]

A

B cells transit in peripheral blood to germinal centres

May detect an antigen, but often this is not specific, so they undergo somatic hypermutation.
- Rapid and aggressive mutation of DNA to try and improve specificity and recognition of their receptor for the antigen
- Go back to bone marrow, become plasma cells and make specific antibodies

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5
Q

Which of the following areas during B cell development is where B cells start the ability to make immunoglobulins

Bone marrow
Blood
Lymphoid tissue
Marrow

A

Which of the following areas during B cell development is where B cells start the ability to make immunoglobulins

Bone marrow
Blood
Lymphoid tissue
Marrow

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6
Q

During B-lymphocyte development, cells start to make antibodies in the lymphoid tissue, before they move back to bone marrow.

What Ig do they make in the lymphoid tissues?

IgA
IgG
IgM
IgE
IgD

A

During B-lymphocyte development, cells start to make antibodies in the lymphoid tissue, before they move back to bone marrow.

What Ig do they make in the lymphoid tissues?

IgA
IgG
IgM
IgE
IgD

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7
Q

State where the following generally occur: [4]

State for the following if they’re generally aggressive or slow [4]

  • ALL
  • CLL
  • Lymphomas
  • Myelomas
A

ALL:
- Bone marrow
- Aggressive

CLL:
- Blood
- Slow

Lymphomas:
- Lymphoid tissue
- Agrresive (high grade); slow (low grade)

Myelomas:
- BM
- Slow

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8
Q

Whats the general rules about prognosis and chance of cure for aggressive or slow diseases? [2]

A

Aggressive:
- Rapidly fatal
- Chance of cure

Low grade:
- Grow slowly
- Much harder to cure

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9
Q

How can you work out if a lymphoma is aggressive or low grade?

A

Low grade lymphomas quite often have pathological descriptions of the cells (e..g follicular lymphoma)

High grade lymphomas are named

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10
Q

For lymphomas, what type of testing do you normally perform for

  • Diagnostic test
  • Prognostic test
  • Staging test
A

Diagnostic test:
- Biopsy; morphology; phenotyping tests
- Sometimes supported by cytogenetic / molecular

Prognostic test:
- Cytogenetic test

Staging test:
- Usually imaging

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11
Q
A
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12
Q

Describe what is meant by lymphoma [1]

What are the two classifications of lymphoma? [2]

A

Type of cancer affecting the lymphocytes inside the lymphatic system

Cancerous cells proliferate inside the lymph nodes, causing the lymph nodes to become abnormally large (lymphadenopathy)

Two classifications:
* Hodgkin’s lymphoma (a specific disease)
* Non-Hodgkin’s lymphoma (which includes all other types)

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13
Q

State and explain which organs are commonly affected in chronic lymphomas [3]

A

Lymphadenopathy
Splenomegaly
Hepatomegaly

Because they’re all germinal centres - which is and important stage in developement in lymphomas

Also get B-symptoms

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14
Q

How do you differentiate between leukaemia and lymphoma from a FBC? [1]

A

Leukaemias tend to have high circulating serum WCCs

Lymphomas tend not to have circulating cells; have solid tumours; enlarged LN with high WCC

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15
Q

How do you differentiate between Hodgkin’s & non-Hodgkin’s lymphoma? [1]

A

Hodgkin’s lymphoma is differentiated from non-Hodgkin’s lymphoma based on its histological appearance of huge multinucleated lymphocytes called Reed-Sternberg cells.

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16
Q

The infection of which pathogen is linked to / often precedes HL? [1]

A

Epstein-Barr Virus

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17
Q

State 4 risk factors for HL [4]

A

EBV

Immunosuppression:
* Organ transplantation
* Immunosuppressant therapies
* Patients with HIV

Autoimmune conditions
* rheumatoid arthritis
* systemic lupus erythematosus
* sarcoidosis

Familial

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18
Q

Which autoimmune conditions increase the liklihood of HL? [3]

A
  • rheumatoid arthritis
  • systemic lupus erythematosus
  • sarcoidosis
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19
Q

Describe what is meant by Hodgkin’s lymphoma

A

Uncontrolled proliferation of B-lymphocytes, causing lymphadenopathy

20
Q

What are the two types of HL? [2]

A

Classical Hodgkin’s lymphoma (95%)

Nodular lymphocyte-predominant Hodgkin’s lymphoma (5%)

21
Q

Describe the features of nodular lymphocyte-predominant Hodgkin’s lymphoma (5%) [4]

A
  • More commonly affects males (75%)
  • Not associated with EBV
  • Absence of Reed-Sternberg (RS) cells, and is characterised by LP (“popcorn”) cells
  • Presents with peripheral adenopathy, and is the only type of Hodgkin’s lymphoma that affects the mesenteric lymph nodes
22
Q

What are the 4 subtypes of classical Hodgkins Lymphoma? [4]

A

Nodular sclerosis:
- Most common subtype, accounts for around 70% of cHL.

Mixed cellularity:
- Accounts for around 20% of cHL.

Lymphocyte-rich:
- Accounts for around 5% of cHL. Has the best prognosis.

Lymphocyte-depleted:
- Rare, accounting for < 1% of cHL. Has the the worst prognosis.

23
Q

Describe the age distribution of patients who suffer from lymphoma [1]

A

It has a bimodal age distribution with peaks around 20-25 and 80 years.

24
Q

Describe the classical clinical features of HL [5]

A

Lymphadenopathy:
- Painless
- Non-tender and firm / rubbery
- Asymmetrical
- Cervical or mediastinal involvement
- Pain in lymph nodes after drinking alcohol

25
Q

Describe the additional clinical features of HL than lymphadenopathy [5]

A

Pel-Ebstein fever
- cyclical fever followed by periods of being afebrile for 1-2 weeks (rare)

Abdominal pain (if abdominal lymphadenopathy is involved)

Pruritus (30%)

Clinical hepato/splenomegaly is rare (although liver and spleen involvement determined by laparoscopy/laparotomy occurs in up to 30% of the patients)

Bone marrow involvement (5-8%)

systemic - ‘B symptoms’ (25%)
* weight loss
* pruritus
* night sweats
* fever (Pel-Ebstein)

26
Q

Describe how you would investigate for HL [4]

A

Blood tests:
- anaemic
- lymphopenic
- thrombocytopenic
- neutrophilia and anaemia indicate a poorer prognosis.

Lymph node biopsy is a critical diagnostic investigation.
* Reed-Sternberg cells
* lacunar cells or popcorn cells

The BMJ Best Practice recs PET scans (93% sensitivity, 87% specificity) for both staging and assessing treatment response post-chemotherapy.

CT, MRI, and PET scans may be used to help diagnose and stage the disease.

27
Q

Describe the Cotswolds-modified Ann Arbor staging system for HL [5]

A

Stage I - limited to a single lymph node region.

Stage II - two or more lymph node regions involved, on the same side of the diaphragm.

Stage III - lymph node regions involved on both sides of the diaphragm.

Stage IV - spread to other organs, such as liver, spleen, or bone marrow, with or without nodal involvement.

Each stage is followed by a letter:

  • A - without B symptoms.
  • B - with B symptoms, including fever, weight loss, night sweats.
  • E - an extra-nodal site involved, that is localised to the known lymph node region.
  • X - bulky disease: mediastinal mass exceeds 1/3 of the intrathoracic diameter or nodal mass >10cm in dimension.
28
Q
A
29
Q

Before you learn in depth the treatment:

This is the handbook

Learn about the general approach to the management and treatment of lymphoma

A
30
Q

Describe the treatment plan for Stage I/II classical Hodgkin’s lymphoma [2]

and

Stage III/ IV classical Hodgkin’s lymphoma [2]

A

Stage I/II classical Hodgkin’s lymphoma:
- Chemotherapy followed by radiotherapy
- Main treatment regimen: ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) + radiotherapy

Stage III/ IV classical Hodgkin’s lymphoma:
- Chemotherapy alone: ABVD or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisolone)

31
Q

Describe the treatment plan for Stage I/ II nodular lymphocyte-predominant Hodgkin’s lymphoma: [1]

and

Stage III/ IV nodular lymphocyte-predominant Hodgkin’s lymphoma [2]

A

Stage I/ II nodular lymphocyte-predominant Hodgkin’s lymphoma:
- Involved-field radiotherapy alone is the main treatment for this group of patients with excellent clinical benefit.

Stage III/ IV nodular lymphocyte-predominant Hodgkin’s lymphoma:
- R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is administered in symptomatic patients or those with rapid disease progression .
- Regular monitoring is adequate in asymptomatic patients.

32
Q

Describe the management plan for HL in refractory disease [2]

A

Chemotherapy followed by autologous stem cell transplantation (ASCT)

Immunotherapeutic agents can be considered:
- Brentuximab vedotin
- nivolumab
- pembrolizumab

33
Q

Describe the common complcations of HL [6]

A

Complications of Hodgkin’s lymphoma are usually chemotherapy or radiotherapy related.

Thyroid:
- Around 50% of the patients who received radiotherapy experience symptoms of hypothyroidism.
- thyroid cancer and hyperthyroidism also possible

Chemotherapy drugs,: especially alkylating agents are associated with secondary malignancies:
- acute myeloid leukaemia
- paraneoplastic syndrome

Cardiac abnormalities:
- doxorubicin are at a higher risk of developing cardiomyopathy
- acute pericarditis shortly after receiving radiotherapy
- valvular heart disease or coronary heart disease in the long-term after radiotherapy

Pulmonary toxicity:
- bleomycin-related pulmonary toxicity
- Radiation-induced pneumonitis

Infertility :(

Infections:
- Neutropenia is common in patients taking chemotherapeutic regimens such as ABVD, and almost all patients receiving BEACOPP are neutropenic.

34
Q

doxorubicin has a risk of causing which cardiac abnormality? [1]

A

doxorubicin causes a higher risk of developing cardiomyopathy.

35
Q

Which of the following types of classical HL is the most common?

Lymphocyte-depleted
Nodular sclerosis
Lymphocyte-rich
Mixed cellularity

A

Nodular sclerosis

36
Q

Which of the following types of classical HL has the worst prognosis?

Lymphocyte-depleted
Nodular sclerosis
Lymphocyte-rich
Mixed cellularity

A

Which of the following types of classical HL has the worst prognosis?

Lymphocyte-depleted

37
Q

Which of the following types of classical HL has the best prognosis?

Lymphocyte-depleted
Nodular sclerosis
Lymphocyte-rich
Mixed cellularity

A

Which of the following types of classical HL has the best prognosis?

Lymphocyte-rich

38
Q

Which of the following types of classical HL is most associated with HIV patients?

Lymphocyte-depleted
Nodular sclerosis
Lymphocyte-rich
Mixed cellularity

A

Lymphocyte-depleted

39
Q

Which of the following types of classical HL is most associated with older patients

Lymphocyte-depleted
Nodular sclerosis
Lymphocyte-rich
Mixed cellularity

A

Which of the following types of classical HL is most associated with older patients

Lymphocyte-rich

40
Q

Which of the following types of classical HL is most associated with mediastinal lymphadenopathy and bulk nodes?

Lymphocyte-depleted
Nodular sclerosis
Lymphocyte-rich
Mixed cellularity

A

Nodular sclerosis

41
Q

Which of the following types of classical HL is most associated with peripheral adenopathy and spleen involvement?

Lymphocyte-depleted
Nodular sclerosis
Lymphocyte-rich
Mixed cellularity

A

Mixed cellularity

42
Q

Which of the following types of classical HL is most associated with retroperitoneal adenopathy and abdominal lymphadenopathy?

Lymphocyte-depleted
Nodular sclerosis
Lymphocyte-rich
Mixed cellularity

A

Which of the following types of classical HL is most associated with retroperitoneal adenopathy and abdominal lymphadenopathy?

Lymphocyte-depleted

43
Q

Which of the following types of classical HL are most asscoiated with EBV? [2]

Lymphocyte-depleted
Nodular sclerosis
Lymphocyte-rich
Mixed cellularity

A

Mixed cellularity
Lymphocyte-depleted

44
Q

How do you stage lymphomas? [1]

Lecture content

A

PET scans

45
Q
A
46
Q
A
47
Q
A

Year 3: Haematology (23 decks)

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