Term
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Definition
- increases every year
- small portion can be attributed to increase in AIDS related lymphomas and lymphomas in immunocompromised patients
- average age at dx is 42 yrs with progressive increase in incidence in age
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Term
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Definition
- no known risk factors in majority of cases
- abberations of immunity
- immunosuppressed pts (inherited and acquired)
- collagen vascular diseases
- renal transplant recipients
- prior Hodgkin's disease
- viruses- HIV, EBV, HTLV-1, HHV-8, hepC
- slight protective effect of moderate alcohol intake in females who dont smoke
- chornic immunologic stimulation- autoimmune disorders, H. pylori
- enviornmental factors
- dietary
- decreased low vegetable intake
- increased red meat intake
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Term
| heterogeneity of lymphomas (cells of origin) |
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Definition
- B cell and T cell (most are B cell)
- follicular center cell
- differentiation state
- immature or transformed (aggressive)
- mature, differentiated (indolent)
- chromosomal translocation leading to activation of different oncogenes
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Term
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Definition
- oncogene activation via chromosomal translocation
- follicular cell lymphoma (14:18)
- increase in BCL-2 which prevents apoptosis and promotes survival
- mantle cell lymphoma (11:14)
- BCL1 (cyclin D1)- regulates cell cycle in G1
- Burkitt's lymphoma (8:14) (2:8) (8:22)
- c myc (promotes proliferation)
- large cell lymphoma
- (3q27) BCL-6 TF: germinal center formation
- 2:5 produces NPM-ALK fusion protein
- CLL (11:19) produce NFkB inhibitor
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Term
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Definition
- history, pe
- CBC, platelet, LFT< LDH, beta 2 microglobulin
- CXR
- CT chest/abdomen/pelvis
- LN biopsy
- BM biopsies/aspirate/cytogenics/flow
- PET scan
- MRI, LP
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Term
| NHL clinical presentation |
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Definition
- LN enlargement (can be any lymph nodes)
- peripheral (local or generalized)
- mediastinal and hilar
- retroperitoneal
- splenomegaly
- extranodal involvement (unlike HD)
- hematologic abnormalities
- B symptoms
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Term
| NHL grading and lymphomas within each type |
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Definition
- low grade (we can tx, but cant cure)
- small lymphocytic/plasmacytoid (ex: CLL)
- follicular small/mised cell (grade 1,2)
- MALT tumor
- marginal zone lymphoma
- intermediate grade
- follicular large cell lymphoma
- mantle cell lymphoma
- diffuse large B cell lymphoma
- peripheral T cell lymphoma
- high grade (very aggressive)
- precursor lymphoblastic leukemia/lymphoma
- T cell type (MAJOR)
- B cell type
- Burkitt's lymphoma
- endemic (Africa), EBV
- found in jaw in Africa, abdominal mass in USA
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Term
| low grade NHL (common translocation, prognosis) |
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Definition
- cause by 14:18 translocation
- we defer tx until symptomatic since no cure
- most pts who present have stage IV disease at presentation (median survival 10-15 yrs)
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Term
| FL grading via peripheral smear |
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Definition
- grade 1 (small cleaved)- less large cells in high powered field
- grade 2 (mixed)- some large cells
- grade 3 (large cell)- many large cells found
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Term
| FL prognositic index parameters |
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Definition
- number of nodal sites- more than 4
- increase LDH levels
- older than 60
- stage III, IV
- hemoglobin level low
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Term
| indications for tx for indolent NHL (FL1 or FL2) |
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Definition
- pain, SOB, pleural or pericardial effusion
- compromise of organ function
- cytopenias due to NHL bone marrow replacement
- enlarged LN causing problems (cosmetic concerns or pain)
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Term
| tx in low grade and advanced stage indolent lymphomas |
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Definition
- limited stage radiotherapy
- in advanced stage, single alkylating agent or combo chemotherapy or total lymphoid irradiation associated with equivalent survival
- purine analoges- rituximab, fludarabine, 2 chlorodeoxyadenosine
- high percentage transform to intermediate or high grade lymphoma
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Term
| prognosis of indolent NHL |
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Definition
- stage 1, 2: half have long term survival
- stage 3. 4
- remission rate very common
- no cure rate
- mean survival 10-12 yrs with longer survival for younger pts
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