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