lymphoma new
TRANSCRIPT
Hematopoietic Malignancies
1048708 Lymphoma is a general term forhematopoietic solid malignancies ofthe lymphoid series
1048708 Leukemia is a general term for liquidmalignancies of either the lymphoidor the myeloid series
Conceptualizing lymphoma
bull neoplasms of lymphoid origin typically causing lymphadenopathy
bull leukemia vs lymphomabull lymphomas as clonal expansions of
cells at certain developmental stages
What is Lymphomabull Lymphomas are cancers that begin by
the ldquomalignant transformationrdquo of a lymphocyte in the lymphatic system
bull Many lymphomas are known to be due to specific genetic mutations
bull Follicular lymphoma due to overexpression of BCL-2 (gene that blocks programmed cell death)
What is the Lymphatic System
bull Made up of organs such as the tonsils spleen liver bone marrow and a network of lymphatic vessels that connect glands called lymph nodes
bull Lymph nodes located throughout the bodybull Lymph nodes filter foreign particles out of the
lymphatic fluid bull Contain B and T lymphocytes
Lymphatic Systembull Lymph nodes act as a filter to
remove bacteria viruses and foreign particles
bull Most people will have had ldquoswollen glandsrdquo at some time as a response to infection
Blood Cell and Lymphocyte Development
STEM CELLS
Multipotential myeloid cells
Multipotential lymphocytic cells
Differentiate amp mature into 6 Types of blood cells
red cells basophilsneutrophils monocyteseosinophils platelets
Differentiate amp mature into 3Types of lymphocytes
T lymphocytesB lymphocytesNatural Killer Cells
Lymphocytesbull Most lymphocytes are in lymph nodes
spleen bone marrow and lymphatic vesselsbull 20 of white blood cells in blood are
lymphocytesbull T cells B cells natural killer cellsbull B cells produce antibodies that help fight
infectious agentsbull T cells help B cells produce antibodies and
they fight viruses
T-Cells and B-Cells
1048708 Immature lymphocytes that travel to thethymus differentiate into T-Cells
ndash ldquoTrdquo is for thymus1048708 Immature lymphocytes that travel to thespleen or lymph nodes differentiate into Bcells
ndash B stands for the bursa of Fabricius which isan organ unique to birds where B cellsmature
ALLALL MM MM CLLCLL LymphomasLymphomas
Hematopoieticstem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloidprogenitor
Myeloproliferative disordersMyeloproliferative disordersAMLAML
Lymphoidprogenitor T-lymphocytes
Plasmacells
B-lymphocytes
nanaiumliumlveve
B-cell development
stemcell
lymphoidprogenitor
progenitor-B
pre-B
immatureB-cell
memoryB-cell
plasma cellplasma cell
DLBCLFL HL
ALL
CLL
MM
germinalgerminalcentercenterB-cellB-cell
maturenaiveB-cell
Clinically useful classification
Diseases that have distinctbull clinical featuresbull natural historybull prognosisbull treatment
Biologically rational classification
Diseases that have distinctbull morphologybull immunophenotypebull genetic featuresbull clinical features
Classification
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Conceptualizing lymphoma
bull neoplasms of lymphoid origin typically causing lymphadenopathy
bull leukemia vs lymphomabull lymphomas as clonal expansions of
cells at certain developmental stages
What is Lymphomabull Lymphomas are cancers that begin by
the ldquomalignant transformationrdquo of a lymphocyte in the lymphatic system
bull Many lymphomas are known to be due to specific genetic mutations
bull Follicular lymphoma due to overexpression of BCL-2 (gene that blocks programmed cell death)
What is the Lymphatic System
bull Made up of organs such as the tonsils spleen liver bone marrow and a network of lymphatic vessels that connect glands called lymph nodes
bull Lymph nodes located throughout the bodybull Lymph nodes filter foreign particles out of the
lymphatic fluid bull Contain B and T lymphocytes
Lymphatic Systembull Lymph nodes act as a filter to
remove bacteria viruses and foreign particles
bull Most people will have had ldquoswollen glandsrdquo at some time as a response to infection
Blood Cell and Lymphocyte Development
STEM CELLS
Multipotential myeloid cells
Multipotential lymphocytic cells
Differentiate amp mature into 6 Types of blood cells
red cells basophilsneutrophils monocyteseosinophils platelets
Differentiate amp mature into 3Types of lymphocytes
T lymphocytesB lymphocytesNatural Killer Cells
Lymphocytesbull Most lymphocytes are in lymph nodes
spleen bone marrow and lymphatic vesselsbull 20 of white blood cells in blood are
lymphocytesbull T cells B cells natural killer cellsbull B cells produce antibodies that help fight
infectious agentsbull T cells help B cells produce antibodies and
they fight viruses
T-Cells and B-Cells
1048708 Immature lymphocytes that travel to thethymus differentiate into T-Cells
ndash ldquoTrdquo is for thymus1048708 Immature lymphocytes that travel to thespleen or lymph nodes differentiate into Bcells
ndash B stands for the bursa of Fabricius which isan organ unique to birds where B cellsmature
ALLALL MM MM CLLCLL LymphomasLymphomas
Hematopoieticstem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloidprogenitor
Myeloproliferative disordersMyeloproliferative disordersAMLAML
Lymphoidprogenitor T-lymphocytes
Plasmacells
B-lymphocytes
nanaiumliumlveve
B-cell development
stemcell
lymphoidprogenitor
progenitor-B
pre-B
immatureB-cell
memoryB-cell
plasma cellplasma cell
DLBCLFL HL
ALL
CLL
MM
germinalgerminalcentercenterB-cellB-cell
maturenaiveB-cell
Clinically useful classification
Diseases that have distinctbull clinical featuresbull natural historybull prognosisbull treatment
Biologically rational classification
Diseases that have distinctbull morphologybull immunophenotypebull genetic featuresbull clinical features
Classification
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
What is Lymphomabull Lymphomas are cancers that begin by
the ldquomalignant transformationrdquo of a lymphocyte in the lymphatic system
bull Many lymphomas are known to be due to specific genetic mutations
bull Follicular lymphoma due to overexpression of BCL-2 (gene that blocks programmed cell death)
What is the Lymphatic System
bull Made up of organs such as the tonsils spleen liver bone marrow and a network of lymphatic vessels that connect glands called lymph nodes
bull Lymph nodes located throughout the bodybull Lymph nodes filter foreign particles out of the
lymphatic fluid bull Contain B and T lymphocytes
Lymphatic Systembull Lymph nodes act as a filter to
remove bacteria viruses and foreign particles
bull Most people will have had ldquoswollen glandsrdquo at some time as a response to infection
Blood Cell and Lymphocyte Development
STEM CELLS
Multipotential myeloid cells
Multipotential lymphocytic cells
Differentiate amp mature into 6 Types of blood cells
red cells basophilsneutrophils monocyteseosinophils platelets
Differentiate amp mature into 3Types of lymphocytes
T lymphocytesB lymphocytesNatural Killer Cells
Lymphocytesbull Most lymphocytes are in lymph nodes
spleen bone marrow and lymphatic vesselsbull 20 of white blood cells in blood are
lymphocytesbull T cells B cells natural killer cellsbull B cells produce antibodies that help fight
infectious agentsbull T cells help B cells produce antibodies and
they fight viruses
T-Cells and B-Cells
1048708 Immature lymphocytes that travel to thethymus differentiate into T-Cells
ndash ldquoTrdquo is for thymus1048708 Immature lymphocytes that travel to thespleen or lymph nodes differentiate into Bcells
ndash B stands for the bursa of Fabricius which isan organ unique to birds where B cellsmature
ALLALL MM MM CLLCLL LymphomasLymphomas
Hematopoieticstem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloidprogenitor
Myeloproliferative disordersMyeloproliferative disordersAMLAML
Lymphoidprogenitor T-lymphocytes
Plasmacells
B-lymphocytes
nanaiumliumlveve
B-cell development
stemcell
lymphoidprogenitor
progenitor-B
pre-B
immatureB-cell
memoryB-cell
plasma cellplasma cell
DLBCLFL HL
ALL
CLL
MM
germinalgerminalcentercenterB-cellB-cell
maturenaiveB-cell
Clinically useful classification
Diseases that have distinctbull clinical featuresbull natural historybull prognosisbull treatment
Biologically rational classification
Diseases that have distinctbull morphologybull immunophenotypebull genetic featuresbull clinical features
Classification
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
What is the Lymphatic System
bull Made up of organs such as the tonsils spleen liver bone marrow and a network of lymphatic vessels that connect glands called lymph nodes
bull Lymph nodes located throughout the bodybull Lymph nodes filter foreign particles out of the
lymphatic fluid bull Contain B and T lymphocytes
Lymphatic Systembull Lymph nodes act as a filter to
remove bacteria viruses and foreign particles
bull Most people will have had ldquoswollen glandsrdquo at some time as a response to infection
Blood Cell and Lymphocyte Development
STEM CELLS
Multipotential myeloid cells
Multipotential lymphocytic cells
Differentiate amp mature into 6 Types of blood cells
red cells basophilsneutrophils monocyteseosinophils platelets
Differentiate amp mature into 3Types of lymphocytes
T lymphocytesB lymphocytesNatural Killer Cells
Lymphocytesbull Most lymphocytes are in lymph nodes
spleen bone marrow and lymphatic vesselsbull 20 of white blood cells in blood are
lymphocytesbull T cells B cells natural killer cellsbull B cells produce antibodies that help fight
infectious agentsbull T cells help B cells produce antibodies and
they fight viruses
T-Cells and B-Cells
1048708 Immature lymphocytes that travel to thethymus differentiate into T-Cells
ndash ldquoTrdquo is for thymus1048708 Immature lymphocytes that travel to thespleen or lymph nodes differentiate into Bcells
ndash B stands for the bursa of Fabricius which isan organ unique to birds where B cellsmature
ALLALL MM MM CLLCLL LymphomasLymphomas
Hematopoieticstem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloidprogenitor
Myeloproliferative disordersMyeloproliferative disordersAMLAML
Lymphoidprogenitor T-lymphocytes
Plasmacells
B-lymphocytes
nanaiumliumlveve
B-cell development
stemcell
lymphoidprogenitor
progenitor-B
pre-B
immatureB-cell
memoryB-cell
plasma cellplasma cell
DLBCLFL HL
ALL
CLL
MM
germinalgerminalcentercenterB-cellB-cell
maturenaiveB-cell
Clinically useful classification
Diseases that have distinctbull clinical featuresbull natural historybull prognosisbull treatment
Biologically rational classification
Diseases that have distinctbull morphologybull immunophenotypebull genetic featuresbull clinical features
Classification
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Lymphatic Systembull Lymph nodes act as a filter to
remove bacteria viruses and foreign particles
bull Most people will have had ldquoswollen glandsrdquo at some time as a response to infection
Blood Cell and Lymphocyte Development
STEM CELLS
Multipotential myeloid cells
Multipotential lymphocytic cells
Differentiate amp mature into 6 Types of blood cells
red cells basophilsneutrophils monocyteseosinophils platelets
Differentiate amp mature into 3Types of lymphocytes
T lymphocytesB lymphocytesNatural Killer Cells
Lymphocytesbull Most lymphocytes are in lymph nodes
spleen bone marrow and lymphatic vesselsbull 20 of white blood cells in blood are
lymphocytesbull T cells B cells natural killer cellsbull B cells produce antibodies that help fight
infectious agentsbull T cells help B cells produce antibodies and
they fight viruses
T-Cells and B-Cells
1048708 Immature lymphocytes that travel to thethymus differentiate into T-Cells
ndash ldquoTrdquo is for thymus1048708 Immature lymphocytes that travel to thespleen or lymph nodes differentiate into Bcells
ndash B stands for the bursa of Fabricius which isan organ unique to birds where B cellsmature
ALLALL MM MM CLLCLL LymphomasLymphomas
Hematopoieticstem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloidprogenitor
Myeloproliferative disordersMyeloproliferative disordersAMLAML
Lymphoidprogenitor T-lymphocytes
Plasmacells
B-lymphocytes
nanaiumliumlveve
B-cell development
stemcell
lymphoidprogenitor
progenitor-B
pre-B
immatureB-cell
memoryB-cell
plasma cellplasma cell
DLBCLFL HL
ALL
CLL
MM
germinalgerminalcentercenterB-cellB-cell
maturenaiveB-cell
Clinically useful classification
Diseases that have distinctbull clinical featuresbull natural historybull prognosisbull treatment
Biologically rational classification
Diseases that have distinctbull morphologybull immunophenotypebull genetic featuresbull clinical features
Classification
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Blood Cell and Lymphocyte Development
STEM CELLS
Multipotential myeloid cells
Multipotential lymphocytic cells
Differentiate amp mature into 6 Types of blood cells
red cells basophilsneutrophils monocyteseosinophils platelets
Differentiate amp mature into 3Types of lymphocytes
T lymphocytesB lymphocytesNatural Killer Cells
Lymphocytesbull Most lymphocytes are in lymph nodes
spleen bone marrow and lymphatic vesselsbull 20 of white blood cells in blood are
lymphocytesbull T cells B cells natural killer cellsbull B cells produce antibodies that help fight
infectious agentsbull T cells help B cells produce antibodies and
they fight viruses
T-Cells and B-Cells
1048708 Immature lymphocytes that travel to thethymus differentiate into T-Cells
ndash ldquoTrdquo is for thymus1048708 Immature lymphocytes that travel to thespleen or lymph nodes differentiate into Bcells
ndash B stands for the bursa of Fabricius which isan organ unique to birds where B cellsmature
ALLALL MM MM CLLCLL LymphomasLymphomas
Hematopoieticstem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloidprogenitor
Myeloproliferative disordersMyeloproliferative disordersAMLAML
Lymphoidprogenitor T-lymphocytes
Plasmacells
B-lymphocytes
nanaiumliumlveve
B-cell development
stemcell
lymphoidprogenitor
progenitor-B
pre-B
immatureB-cell
memoryB-cell
plasma cellplasma cell
DLBCLFL HL
ALL
CLL
MM
germinalgerminalcentercenterB-cellB-cell
maturenaiveB-cell
Clinically useful classification
Diseases that have distinctbull clinical featuresbull natural historybull prognosisbull treatment
Biologically rational classification
Diseases that have distinctbull morphologybull immunophenotypebull genetic featuresbull clinical features
Classification
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Lymphocytesbull Most lymphocytes are in lymph nodes
spleen bone marrow and lymphatic vesselsbull 20 of white blood cells in blood are
lymphocytesbull T cells B cells natural killer cellsbull B cells produce antibodies that help fight
infectious agentsbull T cells help B cells produce antibodies and
they fight viruses
T-Cells and B-Cells
1048708 Immature lymphocytes that travel to thethymus differentiate into T-Cells
ndash ldquoTrdquo is for thymus1048708 Immature lymphocytes that travel to thespleen or lymph nodes differentiate into Bcells
ndash B stands for the bursa of Fabricius which isan organ unique to birds where B cellsmature
ALLALL MM MM CLLCLL LymphomasLymphomas
Hematopoieticstem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloidprogenitor
Myeloproliferative disordersMyeloproliferative disordersAMLAML
Lymphoidprogenitor T-lymphocytes
Plasmacells
B-lymphocytes
nanaiumliumlveve
B-cell development
stemcell
lymphoidprogenitor
progenitor-B
pre-B
immatureB-cell
memoryB-cell
plasma cellplasma cell
DLBCLFL HL
ALL
CLL
MM
germinalgerminalcentercenterB-cellB-cell
maturenaiveB-cell
Clinically useful classification
Diseases that have distinctbull clinical featuresbull natural historybull prognosisbull treatment
Biologically rational classification
Diseases that have distinctbull morphologybull immunophenotypebull genetic featuresbull clinical features
Classification
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
T-Cells and B-Cells
1048708 Immature lymphocytes that travel to thethymus differentiate into T-Cells
ndash ldquoTrdquo is for thymus1048708 Immature lymphocytes that travel to thespleen or lymph nodes differentiate into Bcells
ndash B stands for the bursa of Fabricius which isan organ unique to birds where B cellsmature
ALLALL MM MM CLLCLL LymphomasLymphomas
Hematopoieticstem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloidprogenitor
Myeloproliferative disordersMyeloproliferative disordersAMLAML
Lymphoidprogenitor T-lymphocytes
Plasmacells
B-lymphocytes
nanaiumliumlveve
B-cell development
stemcell
lymphoidprogenitor
progenitor-B
pre-B
immatureB-cell
memoryB-cell
plasma cellplasma cell
DLBCLFL HL
ALL
CLL
MM
germinalgerminalcentercenterB-cellB-cell
maturenaiveB-cell
Clinically useful classification
Diseases that have distinctbull clinical featuresbull natural historybull prognosisbull treatment
Biologically rational classification
Diseases that have distinctbull morphologybull immunophenotypebull genetic featuresbull clinical features
Classification
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
ALLALL MM MM CLLCLL LymphomasLymphomas
Hematopoieticstem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloidprogenitor
Myeloproliferative disordersMyeloproliferative disordersAMLAML
Lymphoidprogenitor T-lymphocytes
Plasmacells
B-lymphocytes
nanaiumliumlveve
B-cell development
stemcell
lymphoidprogenitor
progenitor-B
pre-B
immatureB-cell
memoryB-cell
plasma cellplasma cell
DLBCLFL HL
ALL
CLL
MM
germinalgerminalcentercenterB-cellB-cell
maturenaiveB-cell
Clinically useful classification
Diseases that have distinctbull clinical featuresbull natural historybull prognosisbull treatment
Biologically rational classification
Diseases that have distinctbull morphologybull immunophenotypebull genetic featuresbull clinical features
Classification
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
B-cell development
stemcell
lymphoidprogenitor
progenitor-B
pre-B
immatureB-cell
memoryB-cell
plasma cellplasma cell
DLBCLFL HL
ALL
CLL
MM
germinalgerminalcentercenterB-cellB-cell
maturenaiveB-cell
Clinically useful classification
Diseases that have distinctbull clinical featuresbull natural historybull prognosisbull treatment
Biologically rational classification
Diseases that have distinctbull morphologybull immunophenotypebull genetic featuresbull clinical features
Classification
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Clinically useful classification
Diseases that have distinctbull clinical featuresbull natural historybull prognosisbull treatment
Biologically rational classification
Diseases that have distinctbull morphologybull immunophenotypebull genetic featuresbull clinical features
Classification
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Classificationbull Usually classified by how the cells look
under a microscope and how quickly they grow and spreadndash Aggressive lymphomas (high-grade
lymphomas)
ndash Indolent Lymphomas (low-grade lymphomas)
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Lymphoma classification(2001 WHO)
bull B-cell neoplasmsndash precursorndash mature
bull T-cell amp NK-cell neoplasmsndash precursorndash mature
bull Hodgkin lymphoma
Non-HodgkinLymphomas
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Three common lymphomas
bull Follicular lymphomabull Diffuse large B-cell lymphomabull Hodgkin lymphoma
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Follicular lymphomabull most common type of ldquoindolentrdquo
lymphomabull usually widespread at presentationbull often asymptomaticbull not curable (some exceptions)bull associated with BCL-2 gene
rearrangement [t(1418)]bull cell of origin germinal center B-cell
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
bull defer treatment if asymptomatic (ldquowatch-and-waitrdquo)
bull several chemotherapy options if symptomatic
bull median survival yearsbull despite ldquoindolentrdquo label morbidity and
mortality can be considerablebull transformation to aggressive lymphoma
can occur
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Diffuse large B-cell lymphoma
bull most common type of ldquoaggressiverdquo lymphoma
bull usually symptomaticbull extranodal involvement is commonbull cell of origin germinal center B-cellbull treatment should be offeredbull curable in ~ 40
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
B-Cell Lymphoma (80) bull B-Cells help make antibodies which are
proteins that attach to and help destroy antigensbull Lymphomas are caused when a mutation arises
during the B-cell life cyclebull Various different lymphomas can occur during
several different stages of the cyclendash Follicular lymphoma which is a type of B-cell
lymphoma is caused by a gene translocation which results in an over expressed gene called BCL-2 which blocks apoptosis
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
T-Cell Lymphoma (15)bull The T-cells are born from stem cells
similar to that of B-cells but mature in the thymus
bull They help the immune system work in a coordinated fashionndash These types of lymphomas are categorized
by how the cell is affectedbull Anaplastic Large cell Lymphoma t-cell lymphoma
caused by a gene translocation in chromosome 5
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Mechanisms of lymphomagenesis
bull Genetic alterationsbull Infectionbull Antigen stimulationbull Immunosuppression
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Epidemiology of lymphomas
bull males gt femalesbull incidence
ndash NHL increasingndash Hodgkin lymphoma stable
bull in NHL 3rd most frequently diagnosed cancer in males and 4th in females
bull in HL 5th most frequently diagnosed cancer in males and 10th in females
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Risk factors for NHLbull immunosuppression or immunodeficiencybull connective tissue diseasebull family history of lymphomabull infectious agentsbull ionizing radiation
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Clinical manifestationsbull Variable
bull severity asymptomatic to extremely illbull time course evolution over weeks months or
years
bull Systemic manifestationsbull fever night sweats weight loss anorexia pruritis
bull Local manifestationsbull lymphadenopathy splenomegaly most commonbull any tissue potentially can be infiltrated
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Other complications of lymphoma
bull bone marrow failure (infiltration)bull CNS infiltrationbull immune hemolysis or thrombocytopeniabull compression of structures (eg spinal
cord ureters)bull pleuralpericardial effusions ascites
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Non-Hodgkinrsquos LymphomaStaging
bull Stage is the term used to describe the extent of tumor that has spread through the body ( I and II are localized where as III and IV are advanced
bull Each stage is then divided into categories A B and Endash A No systemic symptomsndash B Systemic Symptoms such as fever night sweats
and weight lossndash E Spreading of disease from lymph node to
another organ
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Stage I Stage II Stage III Stage IV
Staging of lymphoma
A absence of B symptomsB fever night sweats weight loss
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Staging
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Symptomsbull Painful Swelling of lymph nodes located
in the neck underarm and groinbull Unexplained Feverbull Night Sweatsbull Constant Fatiguebull Unexplained Weight lossbull Itchy Skin
Cancer Sourcebook
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Causes and Risk Factors
bull The Exact causes are still unknownndash Higher risk for individuals who
bull Exposed to chemicals such as pesticides or solvents
bull Infected w Epstein-Barr Virusbull Family history of NHL (although no hereditary
pattern has been established)bull Infected w Human Immunodeficiency Virus
(HIV)
Lymphomaorg
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Diagnosis Staging Studies
bull Bone marrow aspiration and biopsybull Radionuclide scans bull GI x-raysbull Spinal fluid analysisbull CT scansbull Magnetic Resonance Imaging (MRI)bull Biopsy
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Treatmentbull Non-Hodgkinrsquos Lymphoma is usually treated
by a team of physicians including hematologists medical oncologists and a radiation oncologist
bull In some cases such as for Indolent lymphomas the Doctor may wait to start treatment until the patient starts showing symptoms known as ldquowatchful waitingrdquo
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Treatment Optionsbull Chemotherapybull Radiationbull Bone Marrow Transplantationbull Surgerybull Bortezomib (Velcade)bull Immunotherapy
bull Using the bodies own immune system combined with material made in a lab
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Survival Ratesbull Survival Rates vary widely by cell type
and staging
ndash 1 Year Survival Rate 77
ndash 5 Year Survival Rate 56
ndash 10 Year Survival Rate 42Cancerorg
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Classical Hodgkin Lymphoma
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Hodgkin lymphomabull cell of origin germinal centre B-cell bull Reed-Sternberg cells (or RS variants)
in the affected tissuesbull most cells in affected lymph node are
polyclonal reactive lymphoid cells not neoplastic cells
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
A possible model of pathogenesis
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV
cytokines
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Hodgkin lymphomaHistologic subtypes
bull Classical Hodgkin lymphomandash nodular sclerosis (most common subtype)ndash mixed cellularityndash lymphocyte-richndash lymphocyte depleted
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Epidemiologybull less frequent than non-Hodgkin
lymphomabull overall MgtFbull peak incidence in 3rd decade
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Associated (etiological) factors
bull EBV infectionbull smaller family sizebull higher socio-economic statusbull caucasian gt non-caucasianbull possible genetic predispositionbull other HIV occupation herbicides
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Clinical manifestationsbull lymphadenopathybull contiguous spreadbull extranodal sites relatively uncommon
except in advanced diseasebull ldquoBrdquo symptoms
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Treatment and Prognosis
Stage Treatment Failure-free
survival
Overall 5 year
survivalIII ABVD x 4
amp radiation70-80 80-90
IIIIV ABVD x 6 60-70 70-80
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Long term complications of
treatmentbull infertility
ndash MOPP gt ABVD males gt femalesndash sperm banking should be discussedndash premature menopause
bull secondary malignancyndash skin AML lung MDS NHL thyroid
breastbull cardiac disease
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-
Lab Diagnostic Studies
bull Lymph node biopsybull Bone marrow aspiration and biopsybull Immunohistochemistry bull Flow cytometrybull Molecular Genetic studiesbull FISHbull Cytogenetics
- Hematopoietic Malignancies
- Conceptualizing lymphoma
- What is Lymphoma
- What is the Lymphatic System
- Lymphatic System
- Blood Cell and Lymphocyte Development
- Lymphocytes
- T-Cells and B-Cells
- PowerPoint Presentation
- B-cell development
- Classification
- Slide 12
- Lymphoma classification (2001 WHO)
- Three common lymphomas
- Follicular lymphoma
- Slide 16
- Diffuse large B-cell lymphoma
- B-Cell Lymphoma (80)
- T-Cell Lymphoma (15)
- Mechanisms of lymphomagenesis
- Epidemiology of lymphomas
- Risk factors for NHL
- Clinical manifestations
- Other complications of lymphoma
- Non-Hodgkinrsquos Lymphoma Staging
- Staging of lymphoma
- Staging
- Symptoms
- Causes and Risk Factors
- Diagnosis Staging Studies
- Treatment
- Treatment Options
- Survival Rates
- Hodgkin lymphoma
- Slide 35
- Slide 36
- A possible model of pathogenesis
- Hodgkin lymphoma Histologic subtypes
- Epidemiology
- Associated (etiological) factors
- Slide 41
- Treatment and Prognosis
- Long term complications of treatment
- Lab Diagnostic Studies
-