Lymphoma and Myeloma Kris3ne Kra4s, M.D.

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

Hematologic Malignancies Leukemias Acute leukemias Chronic leukemias Lymphomas Hodgkin lymphoma Non- Hodgkin lymphoma Plasma cell disorders Mul3ple myeloma

Hematologic Malignancies Leukemias Acute leukemias Chronic leukemias Lymphomas Hodgkin lymphoma Non- Hodgkin lymphoma

Lymphadenopathy

Causes of lymphadenopathy Most common cause overall: benign reac3on to infec3on Most common malignant cause: metasta3c carcinoma

Lymph node anatomy

Reac3ve lymph node

Benign (L) vs. malignant (R)

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

Symptoms of NHL Painless, firm lymphadenopathy Extranodal manifesta3ons B symptoms: weight loss, night sweats, fever

NHL presen3ng as gingival lesion

NHL involving gingiva

NHL presen3ng as palatal lesion

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

Types of NHL Low- grade High- grade Small lymphocy3c lymphoma Malt lymphoma Follicular lymphoma Mycosis fungoides Large cell lymphoma Lymphoblas3c lymphoma BurkiW lymphoma

Small Lymphocy3c Lymphoma Things you must know Small mature lymphocytes Same thing as CLL CD5+ Long course; death from infec3on

Small lymphocy3c lymphoma

MALT Lymphoma Things you must know Occurs in mucosa- associated lymphoid 3ssue Associated with Helicobacter pylori Early on, can be cured with an3bio3cs

MALT lymphoma

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

Follicular lymphoma

I II Follicular lymphoma III

Follicular lymphoma

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

Mycosis Fungoides/Sézary Syndrome Things you must know Skin lesions Blood involvement Cerebriform lymphocytes T- cell immunophenotype

Mycosis fungoides/sézary syndrome

Diffuse Large- Cell Lymphoma Things you must know Large B cells Extranodal involvement Grows rapidly Bad prognosis

Diffuse large- cell lymphoma

Lymphoblas3c Lymphoma Things you must know Typical pa3ent: teenage male with medias3nal mass Lymphoblasts in diffuse pawern Same as ALL* * Which kinds of ALL?

T- Lymphoblas3c lymphoma

T- cell lymphoblas3c lymphoma/t- cell ALL

BurkiW Lymphoma Things you must know Children, young adults Fast- growing Extranodal mass Starry- sky pawern

BurkiW lymphoma

Hodgkin Lymphoma Things you must know Younger pa3ents, good prognosis Con3guous spread Five subtypes Reed- Sternberg cell

Hodgkin lymphoma

Reed- Sternberg cell

Hodgkin lymphoma

Clinical Features of Hodgkin Lymphoma Younger pa3ents Disease o4en localized Prognosis generally good Danger: second malignancies

Mul3ple Myeloma Things you must know Malignant prolifera3on of plasma cells Monoclonal gammopathy Decreased normal immunoglobulins Osteoly3c lesions

Clinical Features of Mul3ple Myeloma Weakness Infec3ons Renal failure Bone pain Hypercalcemia

Mul3ple Myeloma

Serum protein electrophoresis

Treatment of Mul3ple Myeloma Chemo and radia3on Bone marrow transplant 5 year survival with chemo only: 20%