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35 Cards in this Set
- Front
- Back
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what is the overall incidence of non-hodgkin lymphoma?
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20/100'000
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what is the median age for NHL?
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65 years
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what is the M:F ratio in NHL?
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M:F = 1.5:1
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what are principal risk factors for development of a NHL?
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congenital or acquired immunodeficiencies
late complications after radiation oncogenic viruses |
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what are the oncogenic viruses associated with NHL?
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HTLV-1 in adult T-cell lymphoma/leukemia (ATLL)
EBV in endemic and HIV-associated Burkitt lymphoma, less commonly in the sporadic variant of Burkitt lymphoma HHV-8 in Kaposi's sarcoma and primary effusion lymphoma (body-cavity-based lymphoma BCBL) |
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what are other infections associated wtih NHL?
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Helicobacter pylori -> gastric MALT lymphoma
Chlamydia psitacci --> ocular adnexal lymphomas Hepatitis C virus |
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what is the hallmark of the pathogenesis in NHL?
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chromosomal translocations are the genetic hallmark of lymphoid malignancies
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in what pathogenetic mechanisms are NHL different from those in solid tumors?
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genome of the malignant cell is relatively stable in contrast to the generalized random instability especially of solid tumors of epithelial origin
generally there is a lack of microsatellite instability, the hallmark in some hereditary sydromes (leading to predisposition to cancer) and in most sporadic tumors the genome of lymphoma cells is characterized by few non-random chromosomal abnormalities, commonly balanced chromosomal translocations |
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how are NHL staged?
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adapted Ann Arbor classification
Stage I single lymph node region Stage IE single extralymphatic organ or site Stage II more than one lymph node region on the same side of the diaphragm Stage IIE localized involvement of an extralymphatic organ or site Stage III lymph node involvement of both sides of the diaphragm Stage IIIE localized involvement of an extralymphatic organ or site Stage IIIS involvement of spleen Stage IIIES both Stage IV disseminated involvement of extralymphatic organ with or without lymph node involvement additional notes are A for asymptomatic or B for presence of B symptoms |
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what are prognostic tools in NHL?
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International Prognostic Index and variants, originally for high-grade lymphomas
criteria are age>60, abnormal LDH, limited performance status, Ann Arbor stage III/IV and number of extranodal disease sites >1 exceptions are CLL and plasmocytoma |
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what is the median age at diagnosis in NHL?
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sixth decade, exceptions are Burkitt lymphoma [and acute lympoblastic lymphoma (ALL)]
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what proportion of lymphomas are NHL?
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85%
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what proportion of NHL are of B-cell origin
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85%
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which NHL are classified as indolent?
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indolent = low-grade
follicular lymphoma marginal zone lymphoma (MALT, splenic, extranodal) lymphoplasmacytic lymphoma - immunocytoma - Waldenström makroglobulinemia |
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what proportion of NHL, irrespective of cell origin are primarily extranodal?
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20%
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what proportion of peripheral T-NHL are primarily extranodal?
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80%
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which is the organ most commonly affected by T-NHL
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the skin
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which are the most frequent extranodal sites affected in NHL?
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stomach, intestine, skin and brain
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which autoimmune disorders are commonly accompanied by an increased risk for NHL?
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Sjoegren's syndrome
Hashimoto thyroiditis Rheumatoid arthritis Celiac disease |
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is exposure to ionizing radiation a risk factor for NHL?
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no, most commonly identified malignancy following exposure to ionizing radiation is leukemia
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what are groups of differential diagnosis in NHL?
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drug-induced pseudolymphoma syndrome
mycobacterial infections, especially in immunocompromised fungal infections (eg histoplasmosis, cryptococcosis) |
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what are salvage chemotherapy regimens commonly used in recurrent aggressive NHL?
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DHAP
Dexamethasone, high-dose cytarabine, cisplatin ESHAP etoposide, methylprednisolone, high-dose cytarabine, cisplatin EPOCH etoposide, vincristine, doxorubicin, cyclophosphamide, prednisone |
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which epidemiologic phenomena can be seen with advancing age in NHL?
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NHL incidence rising with advancing age, additionally transition from high-grade to low-grade NHL with rising age
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what are the NHL commonly classified as low-grade?
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Follicular Lymphoma
Marginal Zone Lymphoma Small Lymphocytic Lymphoma (cf CLL) |
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what are the NHL commonly classified as intermediate-grade?
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DLBCL
Follicular Lymphoma grade III Mantle Cell Lymphoma |
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what are the NHL commonly classified as high-grade?
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Burkitt and Burkitt-like Lymphoma (BL)
Lymphoblastic Lymphoma (LL) = T-cell variant of ALL |
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what are the three most frequently involved sites of extranodal NHL?
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gastrointestinal tract, skin and brain
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which cytostatic drugs penetrate the blood barrier?
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methotrexate, cytarabine, nitrosourea alkylating agents
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what are mature clonal B-cell neoplasms with accumulation of neoplastic plasmacytoid cells with excretion of a monoclonal Ig molecule?
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MM, extramedullary and solitary plasmocytoma, MGUS, Waldenström macroglobulinemia
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what are other hematologic malignancies in which monoclonal gammopathies can occur?
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B-CLL
indolent NHL cold agglutinin disease amyloidosis |
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what are differences between HL and NHL concerning node involvement?
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node involvement is typically localized to a single axial group of nodes in HL, while involvement of multiple peripheral nodes is more frequent in NHL
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what are differences between HL and NHL concerning dissemination?
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spread in HL is typically orderly by contiguity while NHL show a noncontiguous spread
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what are differences between HL and NHL concerning mesenteric node and Waldeyer ring involvement?
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mesenteric nodes and Waldeyer ring are rarely involved in HL, while they are commonly involved in NHL
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what are differences between HL and NHL concerning extranodal presentation?
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extranodal presentation is rare in HL, while in NHL it is common
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what are the most common fungal infections in leukemic patients?
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aspergillus, candida, zygomycetes (mucorales), fusarium
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