Lymphoma and Myeloma | Kristine Krafts, M.D.

1. Lymphoma and Myeloma | Kristine Krafts, M.D.

2. 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 • Starts in lymph nodes, can spread to blood, marrow • Lymphoid only • Hodgkin or non-Hodgkin

4. Leukemias Hematologic Malignancies • Acute leukemias • Chronic leukemias Lymphomas • Hodgkin lymphoma • Non-Hodgkin lymphoma Plasma cell disorders • Multiple myeloma

5. Leukemias Hematologic Malignancies • Acute leukemias • Chronic leukemias Lymphomas • Hodgkin lymphoma • Non-Hodgkin lymphoma

6. Lymphadenopathy

7. Lymphadenopathy

8. Causes of lymphadenopathy • Most common cause overall: benign reaction to infection • Most common malignant cause: metastatic carcinoma

9. Lymph node anatomy

10. Reactive lymph node

11. Reactive lymph node

12. Reactive lymph node

13. Benign (L) vs. malignant (R)

14. Non-Hodgkin Lymphoma • Malignant proliferation 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 manifestations • “B” symptoms: weight loss, night sweats, fever

16. NHL presenting as gingival lesion

17. NHL involving gingiva

18. NHL presenting as palatal lesion

19. Older patients Indolent (incurable!) Small, mature cells Non-destructive Children, sometimes Aggressive (curable?) Big, ugly cells Destructive Features of Low-Grade vs. High-Grade NHL Low-grade High-grade

20. Small lymphocytic lymphoma Malt lymphoma Follicular lymphoma Mycosis fungoides Low-grade Types of NHL High-grade • Large cell lymphoma • Lymphoblastic lymphoma • Burkitt lymphoma

21. Small Lymphocytic Lymphoma • Small mature lymphocytes • Same thing as CLL • CD5+ • Long course; death from infection Things you must know

22. Small lymphocytic lymphoma

23. Small lymphocytic lymphoma

24. MALT Lymphoma • Occurs in mucosa-associated lymphoid tissue • Associated with Helicobacter pylori • Early on, can be cured with antibiotics Things you must know

25. MALT lymphoma

26. MALT lymphoma

27. Follicular Lymphoma • Follicular pattern (later diffuse) • Small cleaved cell, mixed or large cell • Grade 1, 2, or3 • t(14;18) - IgH and bcl-2 Things you must know

28. Follicular lymphoma

29. I II III Follicular lymphoma

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 additional symptoms B = weight loss, night sweats, fever

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

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 • Large B cells • Extranodal involvement • Grows rapidly • Bad prognosis Things you must know

40. Diffuse large-cell lymphoma

41. Diffuse large-cell lymphoma

42. Lymphoblastic Lymphoma • Typical patient: teenage male with mediastinal mass • Lymphoblasts in diffuse pattern • Same as ALL* * Which kinds of ALL? Things you must know

43. T-Lymphoblastic lymphoma

44. T-cell lymphoblastic lymphoma/T-cell ALL

45. Burkitt Lymphoma • Children, young adults • Fast-growing • Extranodal mass • Starry-sky pattern Things you must know

46. Burkitt lymphoma

47. Burkitt lymphoma

48. Burkitt lymphoma

49. Hodgkin Lymphoma • Younger patients, good prognosis • Contiguous spread • Five subtypes • Reed-Sternberg cell Things you must know

50. Hodgkin lymphoma