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5 - Haematology > Lymphoma > Flashcards

Lymphoma Flashcards

(50 cards)

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1
Q

What is lymphoma?

A

Neoplastic tumour of lymphoid tissue

Often around lymph nodes + bone marrow +/- into blood

Also in other lymphoid tissue such as spleen, MALT (mucosal associated lymphoid tissue)

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2
Q

Epidemiology of Hodgkin’s lymphoma?

A

Males > Females

20 - 29 year olds and 60 + (bimodal)

EBV - associated

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3
Q

How does Hodgkin’s lymphoma spread through the body?

A

Continuously

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4
Q

Clinical features for lymphoma? (4)

A
  • Asymmetrical painless lymphadenopathy +/- obstructive mass effects
  • B symptoms
  • Pain in affected nodes after alcohol
  • Nodes tend to be mediastinal / cervical
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5
Q

What are the B-symptoms seen in Hodgkin lymphoma? (3)

A

Fever >38°C (Pel-Ebstein fever, cyclical 1-2 weeks in a minority)

Drenching night sweats

Weight loss >10% in 6 months (unintentional)

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6
Q

What is a unique symptom some patients with Hodgkin lymphoma experience after alcohol consumption?

A

Pain in affected lymph nodes after alcohol.

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7
Q

Which lymph nodes are commonly affected in Hodgkin lymphoma?

A

Mediastinal and cervical lymph nodes, although other nodes may be involved.

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8
Q

What investigations are used to diagnose Hodgkin lymphoma? (3)

A

CT/PET scan

Tissue diagnosis via lymph node or bone marrow biopsy

Staining for Reed-Sternberg cells (CD15 and CD30 positivity)

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9
Q

What is the characteristic appearance of Reed-Sternberg cells under the microscope?

A

Bi-nucleate/multinucleate cells with an “owl-eyed” appearance on a background of lymphocytes and reactive cells.

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10
Q

What are the subtypes of Hodgkin lymphoma? (5)

A

Classical (~95%):
- Nodular sclerosis (NS)
- Mixed cellularity (MC)
- Lymphocyte-rich (LR)
- Lymphocyte-depleted (LD)

Non-classical (~5%):
- Nodular lymphocyte-predominant

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11
Q

What is the staging system used for Hodgkin lymphoma?

A

Ann-Arbor staging system.

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12
Q

Describe stage 1 of Hodgkin lymphoma.

A

One lymph node (LN) region involved (can include the spleen).

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13
Q

Describe stage 2 of Hodgkin lymphoma.

A

Two or more LN regions on the same side of the diaphragm.

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14
Q

Describe stage 3 of Hodgkin lymphoma.

A

Two or more LN regions on opposite sides of the diaphragm.

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15
Q

Describe stage 4 of Hodgkin lymphoma.

A

Involvement of extra-nodal sites (e.g., liver, bone marrow).

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16
Q

What do the suffixes “A” and “B” indicate in Hodgkin lymphoma staging?

A

A: No constitutional symptoms
B: Constitutional symptoms (B-symptoms)

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17
Q

What is an example of a stage 2A Hodgkin lymphoma presentation?

A

Involvement of 3 LN regions above the diaphragm, pain after alcohol, superior vena cava syndrome, but no weight loss or night sweats.

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18
Q

What is the prognosis of Hodgkin lymphoma?

A

Excellent, especially in young patients, but treatment is intensive.

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19
Q

What is the first-line treatment for Hodgkin lymphoma?

A

Combination chemotherapy (ABVD):

Adriamycin, bleomycin, vinblastine, and dacarbazine.

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20
Q

How many cycles of ABVD chemotherapy are typically used? (2)

A

2-4 cycles for stage 1/2

6 cycles for stage 3/4

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21
Q

What imaging is often used during Hodgkin lymphoma treatment to guide progress?

Study These Flashcards
A

Interim PET scan.

22
Q

When is radiotherapy used in Hodgkin lymphoma treatment? (2)

Study These Flashcards
A

Alongside chemotherapy in bulky disease.

In limited disease.

23
Q

What is a significant long-term risk of radiotherapy for Hodgkin lymphoma in women?

Study These Flashcards
A

High risk of breast cancer.

24
Q

What are the treatment options for relapsed Hodgkin lymphoma? (4)

Study These Flashcards
A

Second-line chemotherapy agents

Brentuximab (anti-CD30)

Pembrolizumab (PDL1 immunotherapy)

Nivolumab

25
How are non - hodgkin lymphoma's classified?
Histolotigically: High grade (Burkitts, diffuse large B cell, Mantle cell) Low grade (Follicular, marginal zone, small lymphocytic) And by cell lineage = T or B cells
26
Which non-hodgkin lymphomas are easier to treat high or low grade?
Higher grade are easier to treat
27
What are the key features of Burkitt's lymphoma? (4)
Very aggressive, fast-growing. t(8;14) translocation leading to c-myc oncogene overexpression. Rapidly responsive to treatment. "Starry sky" appearance on histology (macrophages filled with cellular debris).
28
Burkitt lumyphoma translocation?
t(8;4), leading to c-myc oncogene overexpression
29
What are the three subtypes of Burkitt's lymphoma?
- Endemic (EBV-associated, common in equatorial Africa, jaw and abdominal masses). - Sporadic (found outside Africa, less common jaw involvement, EBV-associated). - Immunodeficiency-associated (non-EBV-associated, seen in HIV or post-transplant patients).
30
Which lymphoma has jaw involvement
Endemic (African) Burkitts non-hodgkin lymphoma
31
What is the treatment for Burkitt's lymphoma? (2)
Chemotherapy with rituximab (anti-CD20 found on B cells). Secondary CNS prophylaxis.
32
What are the key features of Diffuse Large B-cell lymphoma (DLBCL)? (4)
Middle-aged and elderly presentation. Aggressive behavior. Can transform from low-grade lymphoma. "Sheets of large lymphoid cells" on histology.
33
What is the treatment for DLBCL? (2)
Rituximab-CHOP (chemotherapy). Auto-SCT (autologous stem cell transplant) or CAR-T therapy for relapse.
34
What are the key features of Mantle cell lymphoma? (5)
Middle-aged, more common in males than females. Aggressive and disseminated at presentation. Median survival of 3-5 years. t(11;14) translocation leading to cyclin D1 deregulation. "Angular/clefted nuclei" on histology.
35
Translocation seen in Mantle cell lymphoma?
t(11;14) translocation leading to cyclin D1 deregulation.
36
What is the treatment for Mantle cell lymphoma? (3)
Rituximab-CHOP with high-dose cytarabine. Auto-SCT for relapse. Oral options for less fit patients.
37
What are the key features of Follicular lymphoma? (5)
Indolent but mostly incurable. Median survival: 12-15 years. t(14;18) translocation. "Follicular pattern" or "nodular appearance" on histology. Treated with watchful waiting unless compression symtpms = Rituximab/Obinutuzumab plus chemotherapy. (RCHOP)
38
Translocation and expression seen in follicular lymphoma?
t(14;18) = BCL2 overexpression
39
What are the key features of MALT lymphoma? (4)
Marginal zone NHL occurring in middle-aged patients. Associated with chronic antigen stimulation (e.g., H. pylori → gastric MALT lymphoma, Sjogren's syndrome → parotid lymphoma). Treatment involves removing the antigenic stimulus (e.g., H. pylori triple therapy). Chemotherapy may be required.
40
What are the key features of Anaplastic large cell lymphoma? (5)
Affects children and young adults. Aggressive behavior. Large "epithelioid" lymphocytes. t(2;5) translocation. Alk-1 protein expression.
41
Translocation and expression in Anaplastic large cell lymphoma?
t(2;5) translocation. Alk-1 protein expression.
42
What are the characteristics of Peripheral T-cell lymphoma? (2)
Affects middle-aged and elderly individuals. Aggressive, with large T-cells present.
43
What are the key features of Adult T-cell leukemia/lymphoma? (3)
Common in Caribbean and Japanese populations. Associated with HTLV-1 infection. Aggressive disease.
44
What are the key features of Enteropathy-associated T-cell lymphoma (EATL)? (2)
Long standing coeliac Aggressive behaviour
45
What is Cutaneous T-cell lymphoma associated with?
Mycosis fungoides.
46
What monoclonal antibody may be used in managing T-cell lymphomas?
Alemtuzumab (anti-CD52).
47
What does the R-CHOP regimen consist of?
Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone.
48
Translocations for: - Burkitts - Mantle cell - Follicular - Anaplastic large cell
- Burkitts: t ( 8;14 ) - Mantle cell: t ( 11;14 ) - Follicular: t ( 14;18 ) - Anaplastic large cell: t ( 2;5 )
49
Which lymphoma is incurable?
Follicular
50
T cell lymphomas?
Anaplastic large cell Peripheral T cell Adult T cell Enteropathy associated Cutaneous T cell

5 - Haematology (7 decks)

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