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Lymphoma

Lymphoma. Lymphoma is a malignancy of the lymphatic system: 1,2 D ue to the proliferation of lymphocytes Can be of B-cell or T-cell origin Lymphoma is broken into two major classes: 1,2 Non-Hodgkin’s (90% of cases) Hodgkin (10% of cases ). Lymphoma Overview. Lymphoma 1,2,3.

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Lymphoma

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  1. Lymphoma

  2. Lymphoma is a malignancy of the lymphatic system:1,2 • Due to the proliferation of lymphocytes • Can be of B-cell or T-cell origin • Lymphoma is broken into two major classes:1,2 • Non-Hodgkin’s (90% of cases) • Hodgkin (10% of cases) Lymphoma Overview

  3. Lymphoma1,2,3 Non-Hodgkin (NHL) Hodgkin (HL) • Follicular • Diffuse Large B-Cell Lymphoma (DLBCL) • Mantle • Marginal Zone • T-Cell • Burkitt’s • Nodular Sclerosing • Mixed Cellularity • Lymphocyte Rich • Lymphocyte Depleted Lymphoma Classification

  4. Pathology Lymphoma

  5. B-cells in germinal centers • proliferate1,2,4 • Presence of Reed-Sternberg Cells:,1,2 • Owl eye appearance • Can be mononucleated • or binucleated • Can be observed in all • types of Hodgkin’s Reed-Sternberg Cell Hodgkin Lymphoma Pathology Normal Lymphocyte

  6. Uncontrolled proliferation of: • B-cells • T-Cells • NK-Cells • Macrophages Non-Hodgkin Lymphoma Pathology

  7. Epidemiology Lymphoma

  8. Estimated New Cases Diagnosed per year1 Estimated Deaths per year1 Epidemiology of Lymphoma

  9. 4out of5men receive diagnosis beforeage 601 • 3out of 4 women receive diagnosis beforeage 601 • Risk Factors:1,2 • Youth/adolescence • Male • EBV exposure Hodgkin’s Epidemiology

  10. Average age of diagnosis1: 66 • 4thmost common cancer related death in males aged 20-392 • 5thmost common cancer related death in women aged >802 Non-Hodgkin Epidemiology

  11. Non-Hodgkin’s Lymphoma

  12. Non-Hodgkin Lymphoma and Sex

  13. Non-Hodgkin Lymphoma and Sex

  14. Lower levels of estrogen  increased risk of NHL: • Bilateral salpingo-oophorectomy • Higher levels of estrogen  decreasedrisk of NHL: • Menopause hormone therapy use • Increase in number of live births • Oral contraceptive use Estrogen and NHL

  15. Primary Breast Lymphoma

  16. Most common testicular malignancy in men >60 • Good prognosis if diagnosed early • Associated with CNS involvement • HIV-infected males have a higher risk of primary testicular lymphoma. Primary Testicular Lymphoma

  17. Extranodal Involvement

  18. Risk Factors in Women:1,2 • Other B-cell activating autoimmune diseases • Inflammatory Bowel Disease • Atopic Disorder Risk Factors in Men:1 • Alcohol Use • Blood Transfusions Risk Factors for NHL

  19. Alcohol, Smoking, and BMI

  20. Prognosis Lymphoma

  21. Non-Hodgkin lymphoma has a better prognosis for females in general throughout all ethnicities.1 NHL Epidemiology and Prognosis

  22. Non-Hodgkin lymphoma has a higher number of deaths among males throughout all ethnicities.1 NHL Mortality

  23. Women with Hodgkin Lymphoma have an overall betterprognosis.1 Hodgkin Lymphoma Prognosis

  24. Hodgkin Lymphoma Mortality

  25. Reproductive Issues Lymphoma

  26. Chemotherapy Drugs and Associated Infertility Male Fertility *CVP- cyclophosphamide, vincristine, and prednisolone / DBVD- doxorubicin, bleomycin, vinblastine, dacarbazine/ ABVD- Adriamycin, bleomycin, vinblastine, dacarbazine 1 percentage data not available

  27. Alkylating chemotherapy leads to premature ovarian failure in 5-25% of females under 30.1,3 • If treated for childhood cancer, including lymphoma, females experience early menopause.2 • ABVD results in normal fertility.1 • In vitro fertilization for • embryo cryopreservation • should be considered.1,3 Female Fertility

  28. Increased risk with later stages and longer or harsher treatments1,4 • Women taking oral contraceptives during treatment were at less risk of developing amenorrhea.1 • The presence of amenorrhea is predicative of infertility.2 Secondary Amenorrhea

  29. Amenorrhea with Chemotherapy

  30. Males report more decline than women1 • Factors:1,2,3 • Physiological impairments • Rate of therapy induced infertility • Fertility preservation • Sexual quality of life perception Secondary Sexual Dysfunction

  31. Causes:1,2 • Scarring of penile arteries • Destruction of germinal lining of seminiferous tubule • Decrease in testosterone • Loss of interest Male Sexual Dysfunction

  32. Women over 30 who are infertile report the most sexual dissatisfaction.1,2 • Can be due to loss of interest or physiological dysfunction1,2 • Lack of interest could • be due to hypogonadism • or infertility.1 Female Sexual Dysfunction

  33. Pregnancy Lymphoma

  34. Lymphoma symptoms are usually masked by pregnancy symptoms.2 • Higher doses of chemotherapy may need to be administered due to overall increase in blood volume and renal clearance.1 • May need to consider pregnancy termination1,2 • Large B-cell Lymphoma is most commonly diagnosed in pregnancy.1,2,3 • Tends to present in • reproductive organs: • breast >ovaries >uterus Pregnancy and NHL

  35. Hodgkin lymphoma is more common during pregnancy than NHL.1 • There is no difference in diagnosis of stage or prognosis when comparing pregnant women to non-pregnant women.1,3 • Increase in number of pregnancies decreases a woman’s chance significantly for HD.2 Pregnancy and Hodgkin’s

  36. Other Considerations Lymphoma

  37. Mainly caused by radiation above the diaphragm1,2 • Treated before the age of 41 with radiation severely increases chances1 • Combined alkylating chemotherapy and pelvic radiation decreases chances1 • No cases have been reported of male secondary breast cancer.1 Secondary Breast Cancer

  38. Lower QoL Higher QoL Quality of Life

  39. Decreased bone density is associated with lymphoma treatments.1,2,3 • Caused by alkylating agents and high dose glucocorticoids1,2,3 • More common in males >50 years compared to normal population and women >50.1 • Prevention through bisphosphonates during treatment and lifestyle3 Bone Health and Lymphoma

  40. Other Disease Contributions Lymphoma

  41. HIV Related Lymphoma

  42. Men who develop an autoimmune disease are more likely to present with NHL. NHL and Autoimmune Diseases

  43. Treatments Lymphoma

  44. Treatments

  45. Adriamycin Bleomycin Vinblastine Dacarbazine ABVD Allows Anti-mullerian hormone to recover.1 Does not affect fertility in men or women.1

  46. Alkylating treatments include: BEACOPP, MOPP, and CHOP.1,3 • Amenorrhea is a side effect in women over 30.4 • Higher incidence of • infertility in both men and women4 • Not safe during • pregnancy5 Alkylating Agents

  47. ABVD used during 2ndand 3rd trimesters have not shown to cause fetal • abnormalities.4 • Alkylating agents causes teratogenicity and spontaneous abortions.4 • Radiation should be avoided.1 Hodgkin Treatment During Pregnancy

  48. During first trimester, “wait and see” approach may be taken with follicular lymphoma.1 • If using Rituximab, wait 2-3 weeks after stopping treatment to deliver.3 • Anthracyclines and cyclophosphamide proven safer during pregnancy.3 NHL Treatment During Pregnancy

  49. Women experience more hematotoxicity.1,2 • Women experience more anemia and leucopenia.1,2 • Number of infections during treatment were similar in both men and women.1,2 Treatment Toxicity

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