Basics to Brilliance: Haematology Podcast
Welcome to Basics to Brilliance, the Haematology podcast created to supplement & bolster your knowledge for the FRCPath Part 1.
Featuring a two way, non-didactic conversational-style Q&A between the SpR and SHO, this podcast will be your pocket companion no matter where you are.
We aim to cover:
- Malignant and non-malignant topics
- The whole syllabus for FRCPath part 1
- Review UK guidelines
- Go into science/lab detail
- Discuss how guidelines often translate into practice
- Review and appraise hallmark trials
- Discuss future research directions
All readily accessible and completely free of charge!
For every budding haematologist out there, we hope this podcast aids you in your endeavours and fills you with interest and excitement for the brilliant world of Haematology.
Warmest Regards,
Dr. Everden
Dr. Fasey
Dr. Jafri
Note: Guidelines discussed are the most recent as of late 2023/early 2024
Basics to Brilliance: Haematology Podcast
Secondary CNS Lymphoma
- Synchronous CNS and systemic lymphoma at initial presentation (treatment-naïve; TN-SCNSL)
- CNS relapse without recurrent systemic lymphoma (relapsed isolated CNS lymphoma; RI-SCNSL)
- Relapsed concomitant systemic and CNS disease following treatment for systemic lymphoma (RC-SCNSL)
Generally hybrid disease
Investigations
- MRI Head w gadolinium
- PET-CT
- Testicular US (blood testes barrier influences treatment)
- Opthalmoscopy/fundoscopy +/- Vitreal biopsy +/- subretinal aspirate – could need RT
- Lymph node Biopsy
NB: Worthwhile to remember patient hx re relapses
- ?Stereotactic Brain Biopsy w/ Intraoperative rapid cytology and rv of frozen sections......NB: Steroids pre-biopsy may yield non-diagnostic results (1/3 if 7 days steroids)
- Correlate with imaging and timescale
- LP
o Good for leptomeningeal (15%) which can be missed on MRI
o CSF protein levels are prognostic
o Flow cytometry
o Cytospin
o PCR for IGHV rearrangement: sens.
Trial: MARIETTA study, or also known as the IE LSG 42
- Single arm prospective trial, 75 patients
- +/- Steroid pre-phase –>MATRIX + RICE alternating induction x3–>CR/PR ->Carmustine-Thiotepa AutoSCT
- Pre-morbid performance status <=3
- 2-year overall survival for all of those patients included in the trial just under 50%
- NB: cytaribin omissions if poor performance status
- RICE (Ritux isophosphamide, carboplatin and etoposide)…NB, peripheral neuropathy and neurotoxicitiy
- TN-SCNSL best 70% 2 year PFS
- RI-SCNSL 40% 2 year PFS... can also be given just MATRIX
- RC-SCNSL 14% 2 year PFS
- NB if frail elderly, change MATRIX to MARTA
Response assessment :
- TN-SCNSL and RC-SCNSL
o Brain MRI +/- Spine every 2 cycles
o PET scan every 2-3 cycles
o PET and MRI pre-auto, determine least partial response
o End of treatment PET (6-8 weeks post) and MRI
- RI-SCNSL : MRI brain +/- spine every 2 cycles…PET only if suspicion of progression elsewhere
Relapse post MARIETTA :
-BTKi ?compassionate access vs Trial
-ZUMA7 trial: CAR-T (anti CD19) NB : ICANS/CRS….Approved for DLBCL 12 relapse within 12 months and primary refractory disease that hasn’t responded
- PALLIATIVE CARE
NB Immuno-privileged sites :
- Primary Intraocular Lymphoma :
o Stage w PET, MRI head, US Testes
o MATRIX vs MARTA vs PREMAINE as frailty allows (like 1’ CNS) –> AutoSCT
o +/- Occular RT
o Frail++ +-> Intravitreal MTX
- Primary Testicular Lymphoma
o If 1 testicle involved 1/3 of patients have the other involved too
o US Testes –> Orchidectomy + histopathology…if lymphoma ->imaging and investigations as above
o LP with above investigations as 1/3 have CNS involvement
o ?skin lesions sometimes in testicular lymphoma
o RCHOP vs RPolaChP + CNS prophylaxis w MTX
o Radiotherapy (30gy) to contralateral testes to reduce contralateral Relapse risk and/or BL orchidectomy- fertility discussion
o Systemic chemotherapy because of microspread to nodes