lymphoma and myeloma | kristine krafts, m.d
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Lymphoma and Myeloma | Kristine Krafts, M.D. Hematologic Malignancies. Leukemia Malignancy of hematopoietic cells Starts in bone marrow , can spread to blood, nodes Myeloid or lymphoid Acute or chronic Lymphoma Malignancy of hematopoietic cells - PowerPoint PPT PresentationTRANSCRIPT
Lymphoma and Myeloma | Kristine Krafts, M.D.
Leukemia• Malignancy of hematopoietic cells• Starts in bone marrow, can spread to blood, nodes• Myeloid or lymphoid• Acute or chronic
Lymphoma• Malignancy of hematopoietic 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• Multiple myeloma
Hematologic Malignancies
Leukemias• Acute leukemias• Chronic leukemias
Lymphomas• Hodgkin lymphoma• Non-Hodgkin lymphoma
Hematologic Malignancies
Lymphadenopathy
Lymphadenopathy
• Most common cause overall: benign reaction to infection
• Most common malignant cause: metastatic carcinoma
Causes of lymphadenopathy
Lymph node anatomy
Reactive lymph node
Reactive lymph node
Reactive lymph node
Benign (L) vs. malignant (R)
• Malignant proliferation of lymphoid cells (blasts or mature cells) in lymph nodes
• Skips around• Many subtypes• Most are B cell
Things you must know
Non-Hodgkin Lymphoma
• Painless, firm lymphadenopathy• Extranodal manifestations• “B” symptoms: weight loss,
night sweats, fever
Symptoms of NHL
NHL presenting as gingival lesion
NHL involving gingiva
NHL presenting as palatal lesion
• Older patients• Indolent (incurable!)• Small, mature cells• Non-destructive
• Children, sometimes• Aggressive (curable?)• Big, ugly cells• Destructive
Low-grade High-grade
Features of Low-Grade vs. High-Grade NHL
• Small lymphocytic lymphoma• Malt lymphoma• Follicular lymphoma• Mycosis fungoides
Low-grade High-grade
• Large cell lymphoma• Lymphoblastic lymphoma• Burkitt lymphoma
Types of NHL
• Small mature lymphocytes• Same thing as CLL• CD5+• Long course; death from infection
Things you must know
Small Lymphocytic Lymphoma
Small lymphocytic lymphoma
Small lymphocytic lymphoma
• Occurs in mucosa-associated lymphoid tissue• Associated with Helicobacter pylori• Early on, can be cured with antibiotics
Things you must know
MALT Lymphoma
MALT lymphoma
MALT lymphoma
• Follicular pattern (later diffuse)• Small cleaved cell, mixed or large cell• Grade 1, 2, or3• t(14;18) - IgH and bcl-2
Follicular Lymphoma
Things you must know
Follicular lymphoma
Follicular lymphoma
I II III
Follicular lymphoma
Stage I
Stage II
Stage III
Stage IV
Single node
Two or more nodes onsame side of diaphragm
Lymph nodes on both sidesof the diaphragm
Diffuse extranodalinvolvement
90% 5ys
A = no additional symptomsB = weight loss, night sweats, fever
40% 5ys
Staging and Prognosis of Follicular Lymphoma
• Skin lesions• Blood involvement• Cerebriform lymphocytes• T-cell immunophenotype
Things you must know
Mycosis Fungoides/Sézary Syndrome
Mycosis fungoides/Sézary syndrome
Mycosis fungoides/Sézary syndrome
Mycosis fungoides/Sézary syndrome
Mycosis fungoides/Sézary syndrome
Mycosis fungoides/Sézary syndrome
Mycosis fungoides/Sézary syndrome
• Large B cells• Extranodal involvement• Grows rapidly• Bad prognosis
Things you must know
Diffuse Large-Cell Lymphoma
Diffuse large-cell lymphoma
Diffuse large-cell lymphoma
• Typical patient: teenage male with mediastinal mass
• Lymphoblasts in diffuse pattern• Same as ALL*
* Which kinds of ALL?
Things you must know
Lymphoblastic Lymphoma
T-Lymphoblastic lymphoma
T-cell lymphoblastic lymphoma/T-cell ALL
• Children, young adults• Fast-growing• Extranodal mass• Starry-sky pattern
Things you must know
Burkitt Lymphoma
Burkitt lymphoma
Burkitt lymphoma
Burkitt lymphoma
• Younger patients, good prognosis• Contiguous spread• Five subtypes• Reed-Sternberg cell
Things you must know
Hodgkin Lymphoma
Hodgkin lymphoma
Reed-Sternberg cell
Hodgkin lymphoma
• Younger patients• Disease often localized• Prognosis generally good• Danger: second malignancies
Clinical Features of Hodgkin Lymphoma
• Malignant proliferation of plasma cells• Monoclonal gammopathy• Decreased normal immunoglobulins• Osteolytic lesions
Multiple Myeloma
Things you must know
• Weakness• Infections• Renal failure• Bone pain• Hypercalcemia
Clinical Features of Multiple Myeloma
Multiple Myeloma
Multiple Myeloma
Multiple Myeloma
Multiple Myeloma
Multiple Myeloma
Serum protein electrophoresis
Serum protein electrophoresis
Serum protein electrophoresis
• Chemo and radiation• Bone marrow transplant• 5 year survival with chemo only: 20%
Treatment of Multiple Myeloma