Lymphoid Malignancies Flashcards Preview

Yr3 Haematology > Lymphoid Malignancies > Flashcards

Flashcards in Lymphoid Malignancies Deck (22)
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1

Most common lymphoid malignancies?

NHL (high grade)
NHL (low grade)
Hodgkin's lymphoma
CLL
ALL
MM

2

What's the most common high and low grade NHLs?

High grade = Diffuse Large B Cell Lymphoma

Low Grade = Follicular Lymphoma

3

How would you expect to see a lymphoma?

Lymphadenopathy & Hepatosplenomegaly

Can also have extranodal disease, bone marrow involvement and B symptoms (Fever, night sweats & weight loss)

4

What tests would you do on a suspected Lymphoma?

Biopsy the node
Aspirate bone marrow
CT scan

5

What's the difference between high and low grade NH lymphomas?

Low grade = often asymptomatic, not curable but treatable

High grade = Aggressive & fast growing, needs combo-chemo but curable

6

What treatment is used for NH lymphomas?

Combination Chemo (Anti-CD20 monoclonal Abs + Chemo)

7

Who gets Hodgkin's LYmphoma?

It peaks at 15-35yrs then later in life (2nd peak ass with EBV)

More often men.

familial risk and geographical clustering suggest a genetic pattern

8

How would you treat a Hodgkin's Lymphoma?

Combination Chemo (ABVD)
+/- RT
Anti-CD30 MAB
Immunotherapy

9

What would a patient with CLL look like?

Often asymptomatic but when they get problems:
- progressive Bone marrow failure
- Lymphadenopathy
- ~ Splenomegaly, fever & sweats
- Less often hepatomegaly, infections & weight loss

Also immune paresis (no immunoglobulin production)
And Autoimmune Haemolytic Anaemia or ITP

10

How would you stage a CLL patient?

Binet Staging:
A - some nodes
B - more nodes
C - other symptoms or autoimmune

11

When would you treat someone with CLL?

Only if there's signs that it's worsening:
- Progressive marrow failure
- Massive lymphadenopathy
- Progressive Splenomegaly
- Lymphocyte doubling time <6months
- Systemic Symptoms
- Autoimmune Cytopenias

12

How do we treat a case of CLL?

Often just watch and wait. If it's stable they may be better off without treatment

Cytotoxic Chemo e.g. Fludarabine
Monoclonal Abs e.g. Rituximab
Tyrosine Kinase Inhibitors e.g. Ibrutinib

13

What factors would indicate a poor prognosis for CLL?

- Stage B & C
- Atypical lymphocyte morphology
- Rapid lymphocyte doubling time (<12month)
- Loss/mutation of p53
- CD38+ expression
- Unmutated IgVH gene

14

What is required to diagnose cLL?

1) Blood >5x10^9/L lymphocytes
2) Bone Marrow >30% lymphocytes
3) Characteristic Immunophenotyping

15

Who gets ALL?

75% are in kids <6

16

how does ALL present?

Acute (2-3wks) h/o:
- Bone Marrow Failure (Anaemia, bleeds & infections)
- Bone/joint pain
- Infections
- Sweats

17

What do we need to diagnose ALL?

Do a FBC to show low haemonoglobin, low platelets, low neutrophils and high WCC

Confirm with a Marrow biopsy showing >20% lymphoblasts

18

What can we then treat ALL with?

Multiagent Intensive chemo (Induction, Consolidation & Maintenance)

Allogenic stem cell transplant

There are new T cell immunotherapies

19

Poor prognostic factors for aLL?

Older
Higher WCC
Immunophenotype
Certain genetics
Slow/poor response to treatment

20

What are the main T cell immunotherapies for ALL?

BiTe molecules (Bispecific T cell engagers)

CAR T cells (Chimeric Antigen Receptor T Cells)

21

Potential side effects of ALL T-cell immunotherapies?

Cytokine Release Syndrome i.e. fever, hypotension & SOB

Neurotoxicity - Confusion with normal conscious level, seizures, headache, focal neurology & coma

22

Prognosis for ALL?

Adults have a roughly 50% cure rate
Kids more like 90%