Lymphoma and Myeloma Kris3ne Kra4s, M.D.
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1 Lymphoma and Myeloma Kris3ne Kra4s, M.D.
2 Hematologic Malignancies Leukemia Malignancy of hematopoie3c cells Starts in bone marrow, can spread to blood, nodes Myeloid or lymphoid Acute or chronic Lymphoma Malignancy of hematopoie3c cells Starts in lymph nodes, can spread to blood, marrow Lymphoid only Hodgkin or non- Hodgkin
3
4 Hematologic Malignancies Leukemias Acute leukemias Chronic leukemias Lymphomas Hodgkin lymphoma Non- Hodgkin lymphoma Plasma cell disorders Mul3ple myeloma
5 Hematologic Malignancies Leukemias Acute leukemias Chronic leukemias Lymphomas Hodgkin lymphoma Non- Hodgkin lymphoma
6 Lymphadenopathy
7 Lymphadenopathy
8 Causes of lymphadenopathy Most common cause overall: benign reac3on to infec3on Most common malignant cause: metasta3c carcinoma
9 Lymph node anatomy
10 Reac3ve lymph node
11 Reac3ve lymph node
12 Reac3ve lymph node
13 Benign (L) vs. malignant (R)
14 Non- Hodgkin Lymphoma Malignant prolifera3on of lymphoid cells (blasts or mature cells) in lymph nodes Skips around Many subtypes Most are B cell Things you must know
15 Symptoms of NHL Painless, firm lymphadenopathy Extranodal manifesta3ons B symptoms: weight loss, night sweats, fever
16 NHL presen3ng as gingival lesion
17 NHL involving gingiva
18 NHL presen3ng as palatal lesion
19 Features of Low- Grade vs. High- Grade NHL Low- grade High- grade Older pa3ents Indolent (incurable!) Small, mature cells Non- destruc3ve Children, some3mes Aggressive (curable?) Big, ugly cells Destruc3ve
20 Types of NHL Low- grade High- grade Small lymphocy3c lymphoma Malt lymphoma Follicular lymphoma Mycosis fungoides Large cell lymphoma Lymphoblas3c lymphoma BurkiW lymphoma
21 Small Lymphocy3c Lymphoma Things you must know Small mature lymphocytes Same thing as CLL CD5+ Long course; death from infec3on
22 Small lymphocy3c lymphoma
23 Small lymphocy3c lymphoma
24 MALT Lymphoma Things you must know Occurs in mucosa- associated lymphoid 3ssue Associated with Helicobacter pylori Early on, can be cured with an3bio3cs
25 MALT lymphoma
26 MALT lymphoma
27 Follicular Lymphoma Things you must know Follicular pawern (later diffuse) Small cleaved cell, mixed or large cell Grade 1, 2, or3 t(14;18) - IgH and bcl- 2
28 Follicular lymphoma
29 I II Follicular lymphoma III
30 Follicular lymphoma
31 Staging and Prognosis of Follicular Lymphoma Stage I Stage II Stage III Stage IV Single node Two or more nodes on same side of diaphragm Lymph nodes on both sides of the diaphragm Diffuse extranodal involvement 90% 5ys 40% 5ys A = no addi3onal symptoms B = weight loss, night sweats, fever
32 Mycosis Fungoides/Sézary Syndrome Things you must know Skin lesions Blood involvement Cerebriform lymphocytes T- cell immunophenotype
33 Mycosis fungoides/sézary syndrome
34 Mycosis fungoides/sézary syndrome
35 Mycosis fungoides/sézary syndrome
36 Mycosis fungoides/sézary syndrome
37 Mycosis fungoides/sézary syndrome
38 Mycosis fungoides/sézary syndrome
39 Diffuse Large- Cell Lymphoma Things you must know Large B cells Extranodal involvement Grows rapidly Bad prognosis
40 Diffuse large- cell lymphoma
41 Diffuse large- cell lymphoma
42 Lymphoblas3c Lymphoma Things you must know Typical pa3ent: teenage male with medias3nal mass Lymphoblasts in diffuse pawern Same as ALL* * Which kinds of ALL?
43 T- Lymphoblas3c lymphoma
44 T- cell lymphoblas3c lymphoma/t- cell ALL
45 BurkiW Lymphoma Things you must know Children, young adults Fast- growing Extranodal mass Starry- sky pawern
46 BurkiW lymphoma
47 BurkiW lymphoma
48 BurkiW lymphoma
49 Hodgkin Lymphoma Things you must know Younger pa3ents, good prognosis Con3guous spread Five subtypes Reed- Sternberg cell
50 Hodgkin lymphoma
51 Reed- Sternberg cell
52 Hodgkin lymphoma
53 Clinical Features of Hodgkin Lymphoma Younger pa3ents Disease o4en localized Prognosis generally good Danger: second malignancies
54 Mul3ple Myeloma Things you must know Malignant prolifera3on of plasma cells Monoclonal gammopathy Decreased normal immunoglobulins Osteoly3c lesions
55 Clinical Features of Mul3ple Myeloma Weakness Infec3ons Renal failure Bone pain Hypercalcemia
56 Mul3ple Myeloma
57 Mul3ple Myeloma
58 Mul3ple Myeloma
59 Mul3ple Myeloma
60 Mul3ple Myeloma
61 Serum protein electrophoresis
62 Serum protein electrophoresis
63 Serum protein electrophoresis
64 Treatment of Mul3ple Myeloma Chemo and radia3on Bone marrow transplant 5 year survival with chemo only: 20%
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