Dr Amin Islam MB MRCP UK FRCPath UK Consultant Haematologist SUHFT wwwjanaanhealthorg GP Refresher course 3 rd October 2016 Education Centre ID: 532246
Download Presentation The PPT/PDF document "Leukaemia's and lymphomas brief" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Leukaemia's and lymphomas brief
Dr Amin Islam
MB, MRCP UK, FRCPath UK
Consultant Haematologist. SUHFT
www.janaanhealth.org
GP Refresher course
3
rd
October 2016
Education Centre
Southend University Hospital NHS FT Trust
.Slide2
Leukaemia's and lymphomas
An overview of
Common symptoms
Presentations
When to refer
Common types
Diagnosis
Treatments
prognosisSlide3
Common symptoms
lymphomas
Significant weight loss and night sweats
Loss of 10% body weight over 6 months
Drenching night sweats
Asymptomatic lumps
Commonly neck, axillae, groin
Mass can be over soft tissues
Confusion with soft tissue sarcomas/tumoursSlide4
presentations
C
an be rapid or
Gradual onset
Occasional
SVC obstruction
Breathlessness due to pleural effusion
Or collapse due to tracheal compression external
Dysphagia due to oesophageal compressions
Bowel obstruction
Jaundiced due to
porta
hepatis
nodes or liver involvementsSlide5
cont.
Bilateral leg oedema due to pelvic mass
Occasional presentation
Headache and posterior fossa signs symptoms
Back pain
Cord compressions
Urinary obstructions
Autoimmune haemolytic anaemia'sSlide6
When to refer
Difficult some times to
Which specialty to refer?
If symptoms are suggestive or suspicious of lymphomas
Please refer or discuss with us via switch
Urgent ED referral in case of suspected SVCO or respiratory compromise or acute obstructive pictures as aboveSlide7
Common types of lymphomas
Broadly speaking
Hodgkin's lymphomas
Non Hodgkin's lymphomas
Small lymphocytic lymphomas (SLL)Slide8
Hodgkin's
4 subtypes but not graded
All treated as same
Outcome varies slightly according to subtypes
Commonest: nodular sclerosis
Good prognosis: NS
>90% are cured now a daysSlide9
Non Hodgkin's
High grades and
Low grades
Several subtypes
For treatment purposes
Only high grades and low grades are important
Also whether T cell or b cell subtypes are importantSlide10
Commonest types of NHL
High grades
Diffuse large B cell subtypes are the commonest
Angio
immunoblastic
T cell lymphomas
Anaplastic large cell lymphomas
Burkitts LymphomasSlide11
Cntd.
Low grades
Follicular NHL commonest
Mantle cell lymphomas
Lymphoplasmocytic
lymphomas (WM)
Marzinal
zone lymphomas
MALT lymphomasSlide12
Other two types
Small lymphocytic lymphoma SLL
This is a type of CLL but Lymphocytes are <5.0
Diagnosis is base on LN tissue biopsy not from liquid blood flow
cytometry
Treatment is same as CLLSlide13
Cntd.
Nodular lymphocytes predominant
hodgkins
lymphomas
Previously treated as HL
But now a new entity
Treatment and prognosis are different
Treatment as B cell HNLSlide14
Diagnosis
All needs tissue from the involved filed
CT or increasingly PET CT scan for staging
Blood test as part of staging
LDH and B2
microglobulins
prognostics factors
Cytogenetic and molecular
Bone marrow test for staging but not needed for Hodgkin's as PET is sufficient.Slide15
Cntd.
Viral serology mandatory
Hep B, C, HIV
Pulmonary function test for ABVD HL
MRI and CSF if neurological symptoms
ECHO as baseline over 40 or cardiac historySlide16
Treatments
Hodgkin's
All receives ABVD chemotherapy
Limited disease and stage 1-2 A treated with
Courses of chemotherapy then IF radiotherapy
Advanced stage and stage 1-4 B
All receives at least 6 ABVD chemotherapy
No role of HSCT upfront at 1
st
remissionSlide17
Non Hodgkin's
High grade B cell
R-CHOP
CHOP for T cell lymphomas
3-4 courses for stage A 1-2 disease the IF RT
Advanced stage 3-4 or B at least 6 courses
Role of HSCT at 1
st
remission in case of T cell NHLSlide18
Low grade
For B cell
Bendamustine
and
Rituxmab
B-R standard
Watch and wait or R chemo for low grade if treatment indicated
Idelalisib
or clinical trials optionsSlide19
Relapse setting
Depends on
Age , PS and stage, types of lymphomas
Intensive salvage chemo
Leading to ASCT if in remission
Or clinical trials optionsSlide20
prognosis
Excellent in high grade NHL DLBCL 70-80% cures if treated with intensive chemo R-CHOP
T cell: poor only 40-60 in remission but relapse is invariable
Consolidate with ASCT at 1
st
remission
Low grade lymphomas
Overall response 50-70% or palliative approach if frailSlide21
GK DLBCL feb 2015Slide22
GK may 2016 Slide23
KR april 2016Slide24
AA july 2016Slide25
leukaemia's
An overview of
Common symptoms
Presentations
When to refer
Common types
Diagnosis
Treatments
prognosisSlide26
Common symptoms
Sudden or
Gradual onset, non specific abdominal discomfort due to
splenomegally
Symptoms of anaemia's
Petechial
rash due to
thrombocytopepnia
Jaundiced due to ineffective
erythropoiesis
Infections such as pneumonia
Chest symptoms due to either infection or
life threatening pulmonary
leucostasis
and AML
Pyrexia and occasional neurological symptomsSlide27
presentation
Majority acute leukaemia's are picked up by the laboratory
Confirmed by consultant haematologist
Usually have blood test for being unwell or hospital admissions etc
Occasionally dramatic with multi organ failure and DIC
Chest and neurological events
CML usually non specific and abdominal symptoms
CLL asymptomatic mainly blood test for othersSlide28
When to refer
Majority acute
leukaemias
are picked up in the lab and patient/GP contacted urgently
Chronic
High WCC counts with film comments suggestive
Children with non specific any
cytopenia
, bone pains and blood film comments to refer
Lymphocytes >5 and persistent CLL common for adults usually >60 yrs
Any blood film suggest to contact please discussSlide29
Common types
Acute
Commonest AML
denov
MDS-AML
Rare ALL in children rare in adults
Chronic
CLL very common
>70 yrs up to 10%
CML 3-4 cases in southend per yearSlide30
Rare types
T and B PLL
A TLL associated with HTLV1 virusSlide31
Diagnosis
Blood film usually specific
Immunophenotyping to confirm the types
Molecular and cytogenetic to risk stratify
cytogenetic has prognostic values
Bone marrow test
CSF and MRI if neurological involvement rarely neededSlide32
treatments
AML
Intensive chemotherapy at Barts
DA 3+7
We are trying to get AML intensive back to southend collaboration with Barts
Non intensive
MAC locally in southend or palliative best supportive care majority elderlySlide33
ALL rare in adult
Intensive at Barts with UK ALL protocols
Children at GOS ALL protocol for children's
Elderly
Best supportive careSlide34
CLL
FCR is standard
BR for elderly or RP
Relapse setting
Ibrutinib
and
idelalisib
options
Clinical trials option availableSlide35
T cell
Campath
Ideally treated at RMH or Barts
Poor prognosisSlide36
Prognosis
Excellent in childhood ALL>97 cured
AML according to molecular and
cytogenetics
Overall 50% long term survival
Elderly
Outcome poor overall
Some countries 10% elderly survive at 5 yearsSlide37
amlSlide38
ALLSlide39
CLLSlide40
CML