Lymphoma Slides PDF

Lymphomas and overview of management Dr Lawrence Ng Consultant Department of Haematology Singapore General Hospital Overview Presentation/ signs and symptoms Classification Diagnostic workup/ Prognostic workup Management B cell development ...

Lymphomas and overview of management Dr Lawrence Ng Consultant Department of Haematology Singapore General Hospital Overview Presentation/ signs and symptoms Classification Diagnostic workup/ Prognostic workup Management B cell development  WHO Lymphoma Types Precursor B-lymphoblastic Precursor T-lymphoblastic leukemia/ leukemia/ lymphoma lymphoma Aggressive NK-Cell leukemia Burkitt's lymphoma/ leukemia Extranodal NK/T-cell nasal type Diffuse large B-cell lymphoma Anaplastic large cell lymphoma Prolymphocytic leukemia Adult T cell lymphoma/leukemia Mantle cell lymphoma T cell prolymphocytic leukemia Chronic lymphocytic leukemia Enteropathy-associated T-cell lymphoma Lymphoplasmacytic lymphoma Hepatosplenic gamma/delta T-cell lymphoma Marginal zone lymphoma Subcutaneous panniculitis-like T-cell lymphoma Hairy cell leukemia Peripheral T cell lymphoma, NOS Follicular lymphoma Angioimmunoblastic T cell lymphoma Mycosis fungoides/Sézary syndrome T-cell large granular lymphocytic leukemia Hodgkin’s lymphoma  Low-grade lymphoma They are slow-growing. Some of them might have been in the body for months-years without realize. Some might stay silent, in low disease burden and do not cause any harm. In those cases, we could keep a close eye, continue monitor without need to treat, weighting on the risk and benefit of treatment. A small proportion of cases they release abnormal antibody/protein affecting body function, in those cases we need to initiate treatment.  High grade lymphoma Grow rapidly and behave aggressively. Life threatening if left untreated. Some could even involve crucial site: brain/eye/spinal cord/intestine Immediate disease control is crucial  Symptoms of lymphoma It depends on the site of disease. It may present as a lump over your neck, armpit or groin. It may also swell up only inside your chest and abdomen in which could only pick up on scan. When it affect the normal function of the specific organ, you will experience related symptoms. - Eg: lymphoma compressing on urinary tube causing kidney failure, reduce urine volume. Lymphoma occupy the bone marrow causing bone marrow failure. Constitutional symptoms: fatigue, lost of appetite and weight, fever, night sweat Lymphoma can happen almost everywhere. Rare places eg: brain, eye, skin  Sign and symptoms of lymphoma Diagnostic Work-up and Staging Lymph node or Tissue biopsy (excision, core) BM Aspirate and Trephine Imaging (CT thorax/ abd/ pelvis) Imaging (PET/ CT scan) CT scan PET/ CT scan www.uams.edu Bone marrow aspirate and trephine www.healthsystem.virginia.edu Flow Cytometry Cytogenetics (Burkitt lymphoma) Cytogenetics (Burkitt lymphoma) Ann Arbor Staging Diffuse large B cell lymphoma Prognostic factors 1. Age 2. Perf status 3. LDH 4. Extranodal site 5. Stage Sehn. Blood 2007;109:1857. Biologic Prognostic Markers Diffuse large B cell lymphoma Cell of origin (germinal center or non GC) Double-hit (c-myc, Bcl-2) Molecular subtype Intention of Management 1. Curative a. Usually aggressive malignancies except for certain situations (patient, prognosis) b. Intensive chemotherapy + … 2. Non-curative (Control) a. Usually indolent malignancies except for certain subtypes b. Usually less intensive chemotherapy + … Management Chemotherapy – various ways of giving Radiation Immunotherapy – a. monoclonal antibodies b. cellular therapy – allogeneic stem cell Tx c. Immunostimulants d. CAR (chimeric antigen receptor) Targeted therapy  Concept of Treatment Disease factor: low-grade vs high grade Patient factor: fitness Drug efficacy/toxicity Patient Fitness Drug Disease efficacy/toxicit factor/tempo y Chemotherapy Monoclonal Antibody Targeted therapy Autologous stem cell transplantation Chimeric Antigen Receptor T cell Therapy Novel therapies Novel therapies Treatment – DLBCL Coiffier. J Clin Oncol 2005;23:6387 Pola-R-CHP is superior than RCHOP NEJM 2022 Tilly et al Treatment of Diffuse Large B Cell Lymphoma (DLBCL) Wang et al. J Hematol Oncol (2020) 13:175  The End Questions?