Lymphoid Malignancy Flashcards by Martin Beattie

What are the different ways that lymphomas can present?

1) Lymphadenopathy
2) Extranodal Involvement
3) Bone Marrow Involvement
4) Systemic B symptoms

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What are the systemic (B) symptoms associated with lymphomas?

1 - Weight loss (>10% in 6 months)

2 - Fever

3 - Night sweats

4 - Pruritis

5 - Fatigue

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What is the definitive way to define the type of lymphoma?

Biopsy (lymph node or bone marrow)

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What information can clinical examination and imaging give us about a lymphoma?

Where it is

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What are the 2 broad categories of lymphoma?

1) Hodgkin Lymphoma
2) Non-hodgkin Lymphoma

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What is the difference between HL and NHL?

HL - specific disease

NHL: - broad term covering around 50 subtypes of lymphoma

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What are the lymphoproliferative disorders?

Acute Lymphoblastic Leukaemia

Chronic Lymphocytic Leukaemia

Hodgkin Lymphoma

Non-hodgkin lymphoma

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What are the different types of NHL?

High-grade

Low-grade

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What are the characteristics of high-grade NHL?

Diffuse

Large B-cell lymphoma

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What are the characteristics of low-grade NHL?

Follicular

Marginal zone

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Is HL or NHL more common?

NHL is more common than HL

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What is ALL and what are its features?

Acute Lymphoblastic Leukaemia

Cancer of lymphoblasts

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How is ALL diagnosed?

> 20% lymphoblasts present in bone marrow

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What is the most common age group affected by ALL?

Children < 6 years old

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What is the most common presentation of ALL?

2-3 week history of bone/joint pain

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What are the characteristic blood markers of ALL and what is their cause?

All due to bone marrow failure caused by over proliferation of lymphoblasts:

Haemoglobin - Low

WCC - High

Platelets - Low

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Apart from joint pain, what other features are commonly seen in ALL?

1 - Impaired vision (retinal haemorrhages)

2 - Weight loss

3 - Infection

4 - Severe night sweats

How is ALL treated?

1 - Chemotherapy cures systemic disease

2 - Stem cell transplantation if high risk

What are some of the newer therapies available for ALL and what is their general mode of action?

1) BiTe molecules
2) CAR

They are both T-cell immunotherapies

What are the common side effects of T-cell immunotherapy?

1) Cytokine release syndrome
2) Neurotoxicity

What are poor prognostic factors for ALL?

1 - Increasing age

2 - Increased WCC

3 - Poor response to treatment

How is CLL diagnosed?

Blood shows > 5x10^9/L lymphocytes

Bone marrow shows > 30% lymphocytes

B-cell markers and CD5 +VE

Are males or females more affected by CLL?

Males 2:1

How does CLL present?

1 - Often asymptomatic at presentation

2 - Bone marrow failure (anaemia + thrombocytopenia)

3 - Lymphadenopathy

4 - Splenomegaly

5 - Fever and sweats

What is the staging system used for CLL?

Binet

What are the different stages of the Binet system and what are their clinical features?

**A** - \< 3 lymph node areas involved **B** - 3 or more lymph node areas involved **C** - Stage B + anaemia or thrombocytopenia

What are the indications that CLL treatment should be started?

1 - Bone marrow is failing progressively 2 - Massive lymphadenopathy 3 - Progressive splenomegaly 4 - Lymphocyte number doubles in \< 6 months

What is the treatment for CLL?

1 - Watch and wait 2 - Cytotoxic chemotherapy 3 - Monoclonal antibodies

What are poor prognostic factors for CLL?

1 - Binet stage B or C 2 - Abnormal lymphocyte morphology 3 - Rapid lymphocyte doubling time (\<12 months) 4 - Loss of p53 5 - CD 38+ expression

What is the classic presentation of lymphoma?

1) Lymphadenopathy 2) Extranodal disease 3) B symptoms (weight loss, night sweats, pruritis, fever) 4) Hepatic or Spleno megaly 5) Bone marrow involvement

How are lymphomas assessed and 'staged'?

1 - Lymph node biopsy 2 - CT scan 3 - Bone marrow aspirate

How are NHL's classified?

1) According to cell lineage: T-cell B-cell 2) Grade of disease (high or low) 3) Histological features

What cell type do most NHL's originate from?

B-cell

What are the features of a low-grade NHL?

1 - Asymptomatic 2 - Responds to chemo 3 - Slow growing

What are the features of a high-grade NHL?

1 - Aggressive + fast-growing 2 - Requires combination chemo

What are the 2 most common subtypes of NHL and what grade are they?

1) Diffuse large B-cell lymphoma - high grade 2) Follicular lymphoma - low grade

How are NHL's treated?

Monoclonal antibodies + chemotherapy

What is the age distribution for Hodgkin lymphomas?

**Twin peaks:** 1 - 15-35 y.o. 2 - Later in life

With which virus is Hodgkin lymphoma commonly associated with?

Epstein-Barr virus

How is Hodgkin Lymphoma treated?

1) Combination chemo 2) Monoclonal antibodies