Flashcards in Lymphoid Malignancies Deck (22)
Most common lymphoid malignancies?
NHL (high grade)
NHL (low grade)
What's the most common high and low grade NHLs?
High grade = Diffuse Large B Cell Lymphoma
Low Grade = Follicular Lymphoma
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)
What tests would you do on a suspected Lymphoma?
Biopsy the node
Aspirate bone marrow
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
What treatment is used for NH lymphomas?
Combination Chemo (Anti-CD20 monoclonal Abs + Chemo)
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
How would you treat a Hodgkin's Lymphoma?
Combination Chemo (ABVD)
What would a patient with CLL look like?
Often asymptomatic but when they get problems:
- progressive Bone marrow failure
- ~ Splenomegaly, fever & sweats
- Less often hepatomegaly, infections & weight loss
Also immune paresis (no immunoglobulin production)
And Autoimmune Haemolytic Anaemia or ITP
How would you stage a CLL patient?
A - some nodes
B - more nodes
C - other symptoms or autoimmune
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
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
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
What is required to diagnose cLL?
1) Blood >5x10^9/L lymphocytes
2) Bone Marrow >30% lymphocytes
3) Characteristic Immunophenotyping
Who gets ALL?
75% are in kids <6
how does ALL present?
Acute (2-3wks) h/o:
- Bone Marrow Failure (Anaemia, bleeds & infections)
- Bone/joint pain
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
What can we then treat ALL with?
Multiagent Intensive chemo (Induction, Consolidation & Maintenance)
Allogenic stem cell transplant
There are new T cell immunotherapies
Poor prognostic factors for aLL?
Slow/poor response to treatment
What are the main T cell immunotherapies for ALL?
BiTe molecules (Bispecific T cell engagers)
CAR T cells (Chimeric Antigen Receptor T Cells)
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