Hodgkins, Non-Hodgkins, and Chronic Lymphocytic Leukemia Flashcards Preview

Heme Exam 3 > Hodgkins, Non-Hodgkins, and Chronic Lymphocytic Leukemia > Flashcards

Flashcards in Hodgkins, Non-Hodgkins, and Chronic Lymphocytic Leukemia Deck (35):
1

hodgkins disease (HD) etiology:

-10-15% of all lymphomas
-age: bimodal (20-30s and >50)
-more common in whites and males
-85% survival

2

HD - B-symptoms

general symptoms 40% have:
-fevers -chills -night sweats

-pel-ebstein fever - twice day intermittent fever
-pruritus - ITCHING
-alcohol induced pain in LN
-WL

3

HD - lymphadenopathy:

70% cervical LN
60% mediastinal mass
30-40% spleen/para-arortic

non-tender!

4

HD work up?

-biopsy!
-Labs: CBC, LFT,ALP,LDH,ESR,Creat, B2MG
-radiology imaging: CT head to groin or functional study PET with radiolabed glucose
-bone marrow biopsy - unilateral
-staging laparotomy NOT DONE ANYMORE

5

HD staging:

1- 1 nodal region or lymphoid structure

2-2 or more nodal regions or contiguous extralymphatic sites on same side of diaphragm

3- 3 Both sides of diaphragm

4- >1 extranodal site (includes BM)

A-asymptomatic
B-Bsymptoms
X-bulky disease (>10cm or 1/3 width of mediastinum)

6

hodgkins classic malignant cell

redd-sternberg cell - its a B-cell!

7

HD - pathology:

1) Main=reed-sternberg cell
a) B-cell origin
b) CD15 and CD30 (DIAGNOSTIC)
c) comprises the minority of cels
2) histologic subtypes:
a)nodular sclerosis - MOST COMMON
-lymphocyte - reactive
-mixed cellularity
-lymphocyte depletion

8

worst pathology to see for HD?

lymphocyte depletion.. just have some reed sterns but no reactive lymphs

9

**curative therapy for hodgkins?

**CHEMOTHERAPY!
**MULTIPLE DRUG CHEMO!

10

Non-hodgkins (NHL) etiology:

-more common in men, whites, dev coutries
-older people except for two subsets (burkitt and lymphoblastic (ALL-like)

11

Hodgkins cell origin

always B-cell

12

Non hodgkins cell origin

mostly B but can also be t-cell

13

NHL related infections:

-EBV = burkitts and nasopharyngeal lymphoma
-HTLV-1 - adult t cell lymphoma/leukemia
-HCV, HHV8
-helocobacter pylori - gastric MALT lymphoma

14

most common cause of NHL?

prior chemotherapy and/or radiation

15

NHL work up?

same as HD
(-biopsy!
-Labs: CBC, LFT,ALP,LDH,ESR,Creat, B2MG
-radiology imaging: CT head to groin or functional study PET with radiolabed glucose
-bone marrow biopsy - unilateral
-staging laparotomy NOT DONE ANYMORE)

***EXCEPT:
-B-sx = fever, chills, NS, and WL ONLY
-LN biopsy and BM biopsy - flow cytometry, immunophenotyping and cytogenics
-lumbar puncture requried if: epiduar, testicular, nasopharyngeal involvment; burkitts, lymphoblastic, HIV lymphoma

16

2 most common NHL?

large cell (B, T, or ind cell)
follicular (b-cell)

17

NHL classification:

1) Indolent (low grade) -
a) follicular
b) mantle cell
c) small lymphocytic
d) splenic lymphoma
e) MALT
f) hairy cell
2) Aggressive (intermediate grade)
a) diffuse large cell
b) anaplastic large cell
c) immunoblastic
3) very aggressive (high grade) (act like acute leukemia)
a) burkitts (small, noncleaved)
b) lymphoblastic or any t-cell lymphoma

18

Diffuse large-cell lymphoma (DLCL)
etiology:

1) 30% of all NHL
2) enlarging mass in nodal or extranodal site
3) frequently symptomatic from node of contritutional
4) occurs at all ages, more common >60
5) extranodal sites in 40%
6) median survival 4 yrs
7) overall cure rate 45%
8) most relapses occur within 3 years

19

International Prognostic index for DLCL - what are the prognostic factors?

worst status and best status?

-stage 3 or 4
->1 extranodal site
-age>60
-LDH elevated
-performance status 2-4

worst=3+ factors=55%4yr survival
best=0 factors =94% 4 yr survival

20

DLCL treatment?

-MUTLIDRUG CHEMO!
--CHOP drugs - is curative

21

New standard of care for DLCL treatment?

CHOP + rituximab

22

rituximab is what kind of drug?

its an anti-CD20 antibody
monoclonal - very preferential!

23

indolent (low grade) lymphoma
-types?
-symptoms?
-when does it occur?
-what is most often presenting stage?
-median survival?

-follicular and small lymphocytic lymphoma
-enlarging LN over months to year and can come and -- usually why 80% present with stage 3 or 4 (LIMITED TO LN, LIVER< SPLEEN AND MARROW)
-occurs middle to late age
-medial survival 6-12 years
**-incurable in advanced stages** - these folks with late stages arent cured!
-35-40% of follicular lymphoma will transform into DLCL at 10 years of disease - can become curable so it might not be a bad thing (richters transformation)

24

indolent lymphoma - treatment: goals:

-follicular stage 1/2 = goal is to cure; RT has 40-50% cure rate

(MOST PEOPLE HERE)-follicular stage 3/4 or SLL=goal is to relieve symptoms/promote longetivity; RT for large painful nodes; systemic therapy: constituation symptoms or cytopenias (CHOP like stuff)
TREAT WHEN DISEASE STARTS TO AFFECT THE PATIENT

25

Very aggressive NHL etiology:
types
who gets?
what is this disease like?

-lymphoblastic; burkitts, any t-cell

-peds and young adults

- acts like and treated like acute lymphoblastic leukemia (ALL): Curable but very aggressive - need intense chemo with IV and CNS injected

26

BM and Stem cell transplant:
-when do we do it?
-which conditions?

-if people dont respond to chemo or relapse after treatment

-DLCL and very aggressive lymphomas
-DO NOT DO FOR follicular (indolent) lymphomas - IT DOESNT WORK

27

MALT lymphoma
-what the hell is it?

-falls in low grade non hodgins lymphoma group
MOST COMMON-mucosa associated lymphoid tissue: GI, lung, salivary glands, thyroid, skin, indolent lymphoma
-gastric MALT lymphoma: H pylori + or - -- terat bug with that triple therapy if not use radiation

28

HIV associated:
-whcih grouP?
where affect?
-other viruses involved?
-prognostic factor?
survival?

-aggressive or very aggressive group
-DLCL, burkitts, or CNS lymphoma

-multiple extranodal sites: anus, rectum, soft tissues, pleural fluid

-HHV8 and EBV

-low CD4 count is worse

-med survival is 6mo

29

chronic lymphocytic leukemia
-etiology

-most common leukemia - makes up 1/3 of all leukemias

-median age at Dx is 72 with death at 79

-most are sporadic
-immune def conditions

30

most common leukemia?

CLL

31

CLL - pathology:

-clonal proliferation of incompetent mature lymphocytes
-always in both bone marrow and periph blood
-ALWAYS B-CELL

32

CLL clinicl presentation
-labs:

-high WBC >5000
-low IgG, IgA, and IgM levels in later stages
-CD5, CD20, and CD23 via flow cytometry
-bone marrow biopsy shows > 40% mature lymphocytes

33

Staging of CLL:

Stage0=lymphocytosis - low risk
Stage1=lymphadenopathy-med risk
stage 2=splenomegaly-med risk
stage3=anemia(HB<100K- high risk

34

Is CLL curable?

NO

35

when to treat CLL?

-stage 3 or 4
-persistent symptoms
-lymphadenopathy causing medical probs or cosmetic issues
-immune related hemolytic anemia or thrombocytopenia