Lymphoid Malignancy Flashcards
(22 cards)
What is the presentation of lymphoma?
- Lymphadenopathy
- +/- extranodal or bone marrow involvement
- B symptoms: weight loss, fever, night sweats, pruritis and fatigue
How can a lymphoma or leukaemia be diagnosed?
- Biopsy (lymph node, bone marrow etc.) - tells us what type it is
- Examination and imaging give the staging
Name the commonest lymphoid malignancies
- High grade NHL
- Low grade lymphomas
- Hodgkin lymphoma
- CLL
- ALL
How does acute lymphoblastic leukaemia present?
- 2/3 week history of bone marrow failure or bone/joint pain
- Weight loss
- can be SOB or have impaired vision
- Infection and night sweats
What investigations should be done for ALL?
- FBC: low haemoglobin, raised WCC and low platelets
- Bone marrow biopsy
Describe the characteristics of ALL cells
- Large cells
- Express CD19 (all B cells have this)
- CD34 and TDT: markers of very early immature cells
How can ALL be treated?
- Induction chemotherapy
- Consolidation therapy
- CNS directed treatment
- Maintenance treatment for 18 months
- Stem cell transplantation (if high risk)
- New therapies: Bi-specific T cell engagers and CAR)
What are the side effects of T cell immunotherapy?
- Cytokine release syndrome: fever, hypotension and dyspnoea
- CAR T cell - significant number require ICU support
- Neurotoxicity: confusion, normal conscious level, seizure, headache, focal neurology and coma
What are the poor risk factors for ALL?
- Increasing age
- Increased white cell count
- Cytogenetics/molecular genetics: t(9;22) an t(4;11)
- Slow/poor response to treatment
How does CLL present?
- Bone marrow failure (anaemia and thrombocytopenia)
- Lymphadenopathy
- Splenomegaly
- Fever and sweats
What can be associated with CLL?
- Immune paresis
- Haemolytic anaemia
What is the staging system for CLL?
Binet:
- A: <3 lymph node areas
- B: 3 or more lymph node areas
- C: stage B + anaemia or thrombocytopenia
What are the indications for treatment in CLL?
- Progressive bone marrow failure
- Massive lymphadenopathy
- Progressive splenomegaly
- Lymphocyte doubling time < 6 months
- Systemic symptoms
- Autoimmune cytopenia
What are the treatment options for CLL?
- Often watch and wait
- Cytotoxic chemotherapy
- Monoclonal antibodies
- Novel agents: Bruton tyrosine kinase inhibitor, PI3K inhibitor and BCL-2 inhibitor
What are the poor prognostic factors for CLL?
- Advanced disease (stage B or C)
- Atypical lymphocyte morphology
- Rapid lymphocyte doubling time
- CD38+ expression
- Loss/mutation of p53 or deletion of 11q23
- Unmutated IgVH gene status
How do lymphomas present?
- Lymphadenopathy
- Hepatosplenomegaly
- Extranodal disease
- B symptoms
- Bone marrow involvement
How can lymphoma be assesed?
- Lymph node biopsy
- CT scan
- Bone marrow aspirate
- Trephine
How is lymphoma staged?
-Stage 1: one node
-Stage 2: two nodes on one side of the diaphragm
-Stage 3: multiple nodes on both sides
-Stage 4: stage 3 + bone or organ involvement
A: absence of B symptoms
B: B symptoms (fever, night sweats and weight loss)
What are the differences between low and high grade non-hodgkins lymphoma?
- Low grade: often asymptomatic, responds to chemo and is incurable
- High grade: aggressive, fast growing, requires combination chemotherapy and can be cured
What are the commonest forms of lymphoma and how are they treated?
- Diffuse large B cell lymphoma (high grade)
- Follicular lymphoma (low grade)
- Combination chemotherapy (monoclonal antibody + chemo)
Which virus is associated with Hodgkins lymphoma?
EBV
How can Hodgkin’s lymphoma be treated?
- Combination chemo
- +/- radiotherapy
- Monoclonal antibodies
- Immunotherapy (checkpoint inhibitors)
- PET scanning to assess response to treatment
