Leukaemia's and lymphomas brief - PowerPoint Presentation

Leukaemia's and lymphomas  brief
Leukaemia's and lymphomas  brief

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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

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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

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