pbl 6 – lymphoma and leukemia
DESCRIPTION
PBL 6 – Lymphoma and leukemia. Age bracketing leukemia . 0 – 14 15 – 39 (clue: peripheral blood smear will have blasts with Auer rods) 40 – 59 > 60. How do you distinguish AML from CML?. - PowerPoint PPT PresentationTRANSCRIPT
PBL 6 – Lymphoma and leukemia
Age bracketing leukemia
0 – 14 15 – 39 (clue: peripheral blood smear will have blasts with Auer rods)40 – 59 > 60
How do you distinguish AML from CML?
Perform a bone marrow aspirate. If <30% of WBCs in the marrow are blasts then you have a chronic CML, whereas if >30% of WBCs are blasts it is acute.
What are more common, NHL or HL?
What is the most common form of NHL?
Ann Arbor classificationI, II, III, IV, E, S, A, B
Hodgkin Non-Hodgkin
Localised or more generalised?Contiguous spread?
Commonly affects Waldeyer ring and mesenteric nodes?Commonly has extra-nodal presentation?
Hodgkin Non-HodgkinOften localised to a single axial group of nodes (cervical, mediastinal, para-arotic)
More frequent involvement of multiple peripheral nodes
Orderly contiguous spread Non-contiguous spread
Rarely mesenteric node and Waldeyer ring involvement
Often Waldeyer ring and mesenteric nodes involvement
Extra-nodal presentation rare Extra-nodal presentation common
Which of the following NHLs are associated with Epstein Bar Virus (EBV)
Diffuse large B-cell lymphoma
Burkett’s lymphoma
Primary CNS lymphoma (common patient’s who also have…?)
Follicular B-cell lymphoma
Structures that may cause lower back pain
Red flags for lower back pain
Which NHL demonstrates the following histology?
What type of NHL demonstrates this pathology? What is it’s prognosis?
What type of NHL demonstrates this pathology? What is it’s prognosis?
Common Lymphoma patternsDiffuse large B cell Follicular B-cell
lymphomaHodgkin’s
Incidence
Age
Node distribution
Diaphragm
Splenomegaly
Bone marrow involvement
Extranodal disease
Treatment
Common Lymphoma patternsDiffuse large B cell Follicular B-cell
lymphomaHodgkin’s
Incidence Around 25% Around 20% Around 11%
Age Incidence increases with age Bimodal; first around 20-30 and second rise after 50
Node distribution Mostly localised mass Usually generalised Often localised; axial distribution
Diaphragm Either side Generalised Most frequently above
Splenomegaly Uncommon Much more common Uncommon
Bone marrow involvement Less common More common Rare
Extranodal disease Frequent Less common Rare
Treatment Curative. R-CHOP Cure is unlikely. Often watch and wait or simple +/- Rituximab. Advanced stage may be given agggressive chemo.
Curative. Early stage radiation, later stage chemotherapy. ABVD
ABVDDoxorubicin (Adriamycin)
Cytotoxic antibiotics (mitomycin), inhibit DNA and RNA synthesis by intercalation of DNA base pairs and prevent DNA repair by inhibiting topoisomerase II, i.e. inserts between DNA base pairsBleomycin
Free radical. Inhibits DNA and to a lesser extent RNA synthesis, produces single and double strand breaks in DNA possibly by free radical formation.
Vinblastin Tubulin-binding drugs (aka Vinca Alkaloids including vincristine, taxol), inhibit mitosis at
metaphase by binding to tubulin and inhibiting its polymerisation into microtubules, preventing spindle formation in dividing cells, i.e. arrest metaphase.
DacarbazineAlkylating agent (cyclophosphomide***, cisplatin), i.e. binds to, and forms cross-linking
between, DNA strands thus interfering with cellular transcription and replication
R-CHOPRituximab
Monoclonal antibody. Anti-CD20 monoclonal antibody that binds to CD20 on B lymphocytes and starts an immune response that lyses normal and malignant B cells. Apoptosis is also induced. Regeneration of normal B lymphocytes occurs.
Cyclophosphamide
Hydroydaunorubicin
Oncovin® (Vincristine)
Prednisolone
Corticosteroids : MOA
1. Lipophilic steroid molecules diffuse through lipid membrane of cells and bind to cytoplasmic, intracellular glucocorticoid receptor
2. Steroid receptors undergo confirmational change which reveals DNA binding site
3. Receptors form dimers which enter nucleus4. Dimers bind to promoter regions of target gene
and cause either induction or repression of gene transcription