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ALL
CLL
Lymphomas
MM
nave
B-lymphocytes
Lymphoid
progenitor
AML
Hematopoietic
stem cell
Myeloid
progenitor
Plasma
cells
T-lymphocytes
Myeloproliferative disorders
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
B-cell development
CLL
stem
cell
lymphoid
progenitor
mature
naive
B-cell
germinal
center
B-cell
MM
progenitor-B
ALL
memory
B-cell
pre-B
immature
B-cell
DLBCL,
FL, HL
plasma cell
Diseases:
AML
Pro-B-ALL
Pre-B-ALL
B-ALL
-MGUS
-B-CLL
-Multiple Myeloma
-DLBCL
-Plasmacytoma
-FLL
-BL
-Mantle Cell lymphoma
-Marginal Zone lymphoma
-MALT
-GALT
-Hodgkins (?)
Mantle zone
lymphoma
Chronic lymphocytic
leukemia
Small lymphocytic lymphoma
Waldenstrms macroglobulinemia
Follicular lymphoma
Burkitts lymphoma
Szary syndrome
Mycosis fungoides
Peripheral T cell
lymphoma
Lymphoma classification
(2001 WHO)
B-cell
neoplasms
precursor
mature
T-cell
precursor
mature
Hodgkin
lymphoma
NonHodgkin
Lymphomas
Lymphomas
15%
85%
Hodgkins
Non Hodgkins
B Cells Nodular sclerosing 50%
Mixed cellularity 30-40%
T Cells
Hodgkin Disease
Hodgkin Disease
Definition:
Hodgkin Disease
Incidence:
Epidemiology Hodgkins
Bimodal
Postulated
to have
infectious
association
Clinical Presentation
Pel-Ebstein fever.
relapsing, high-grade fever that can reach 105-106F,
periodicity of 7-10 days. Fever spikes abrupt in onset
and resolution
other symptoms
Pel-Ebstein Fever
Investigations
CBP
:
Anemia ( normochromic / normocytic), eosinophilia,
neutrophilia, lymphopenia
ESR
LFT- (liver infil / obs at porta hepatis)
RFT- prior to treatment
Urate , Ca,
LDH - adverse prognosis
CXR- mediastinal mass
CT thorax / abdomen / pelvis-for staging
Other: Gallium scan, PET, Lymphangiography ,
Laporotomy
Excisional biopsy of a lymph node
Staging of lymphoma
Stage I
Stage II
Stage III
A: absence of B symptoms
B: fever, night sweats, weight loss
Stage IV
Non-Hodgkin
lymphoma
Hodgkin
lymphoma
Survival of
untreated
patients
Curability
To treat or
not to treat
Indolent
Years
Generally not
curable
Generally defer
Rx if
asymptomatic
Aggressive
Months
Curable in
some
Treat
Very
aggressive
Weeks
Curable in
some
Treat
All types
Variable
months to
years
Curable in
most
Treat
Small lymphocytic
Immunoblastic
Mantle cell
Large Cell
Etiology of NHL
Immune
suppression
congenital
(Wiskott-Aldrich)
organ transplant (cyclosporine)
AIDS
increasing age
DNA
repair defects
ataxia
telangiectasia
xeroderma pigmentosum
Etiology of NHL
Chronic
Helicobacter
causes
EBV
Regimen
Drugs
CHOP
BACOP
M-BACOD
ProMACE/MOPP
MACOP-B
Treatment Options in
Advanced Indolent Lymphomas
Observation
only.
Radiotherapy to site of problem.
Systemic chemotherapy
oral
Antibody
Zevalin.
Stem cell or bone marrow transplant.
Hodgkin's Lymphoma
VS
Non-Hodgkin's Lymphomas
Men 0.23%
Women 0.20%
Men 2.12%
Women 1.79%
Location
Affected Lymph
Cells
B limfosit
Disease occurs outside the nodes in about 4% of
cases.
characterized
by the Reed-Sternberg Cell
Age
Chance of getting
in all people over
an entire lifetime
Occurrence
Symptoms
Progression
Multiple Myeloma
Multiple Myeloma
More
Bence
than 3 gm/dL.
Clinical Features
Bone
marrow failure
- Anemia, thrombocytopenia,
neutropenia
Renal failure
Bone disease with skeletal destruction
lytic lesions
generalized decrease in bone density
Hypercalcemia
immunoglobulins
Alb. 1 2
Alb. 1 2
lymphoma
Monoclonal gammopathy of
undetermined significance (MGUS).
Not clinically significant unless present
in high quantity (over 3 gm/dL).
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