Lymphoma: Diagnosis And Management 19.01.24 Flashcards
What is lymphoma
Clonal proliferation and spread of a malignant lymphocyte - predominantly disease of lymph nodes
What causes lymphoma
Failure of immune surveillance and regulation
Impairment of immune system itself
Acquisition of new capabilities in malignant cells
Causes of lymphoma
Idiopathic
Primary (Congenital) Immunodeficiencye.g. Wiscott-Aldrich Syndrome, CVID
Secondary Immunodeficiencye.g. HIV, Transplant Recipients
Infectione.g. EBV, HTLV-1, Helicobacter Pylori
Autoimmune Disease
What are B symptoms
Weight loss
Fever
Night sweats
How is lymphoma diagnosed?
Lymph node biopsy
Blood film/bone marrow biopsy
Immunophenotyping/immunohistochemistry
Cytogenetics
Molecular techniques
Presentation of Hodgkin lymphoma
Painless lymphadenopathy
B symptoms
What cells must be present to diagnose Hodgkin lymphoma
Reed-Sternberg cell
Features of low grade non Hodgkin lymphoma
E.g. Follicular Lymphoma, Marginal Zone Lymphoma
Slow Growing
Usually advanced at presentation
Incurable
Median Survival 9-11 years
Wide range of treatments
What to do to treat/manage low grade non-Hodgkin lymphoma
Watch + Wait
Alkylating Agentse.g. Cyclophosphamide, Chloramubucil
Combination Chemotherapy
Purine Analoguese.g. Cladribine, Fludarabine
Radiotherapy
Monocloncal Antibodies e.g. Rituximab, Polatuzumab
Novel targeted agents e.g. Ibrutinib, Venetoclax
Features of high grade non Hodgkin lymphoma
e.g. Diffuse Large B Cell Lymphoma
Usually nodal presentation
1/3 cases have extranodal involvement
Patient usually unwell
Often short history
Management of high grade non-Hodgkin lymphoma
Early -
Short course chemotherapy + RT
e.g. 3# R-CHOP & IFRT
Advanced -
Combination chemotherapy + monoclonal antibodies
e.g. 6# R-CHOP
Treatment of high grade non-Hodgkin lymphoma
Monoclonal antibody e.g. rituximab
Immuno-conjugates
Bi-specific antibodies
Autologous car-t cells
