Episode 110 - Size Matters | Diffuse Large B Cell Lymphoma

They say a picture is worth a thousand words but sometimes there’s only one word you need to know - Lymphoma. Sadly it turns out that’s not enough to pass your morphology exams so join the boys (who have now recovered enough from the trauma of their own examinations to talk about them) and chat about characteristic appearances of lymphoma on the peripheral smear.TIMESTAMPS0:52 - Nick gets cultured (not microbiologically)2:54 - Talkin' bout morphology4:05 - General principles6:16 - Normal lymphocytes7:12 - Reactive lymphocytes13:00 - CLL16:45 - Follicular lymphoma17:43 - Mantle cell lymphoma19:05 - Marginal zone lymphoma21:30 - Lymphoplasmacytic lymphoma24:56 - Hairy cell leukaemia27:16 - Aggressive B cell lymphomas29:41 - Myeloma31:55 - T cell morphology33:15 - Mycosis fungoides/Sezary syndrome34:56 - T-LGL36:10 - T-PLL39:08 - A-TLL41:18 - Example cases45:25 - Weird lymphocyte inclusions45:58 - Study tips for the morph exam47:35 - Lol we were notSupport the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

This is getting out of hand, now there are two of them (Dr Nicks). Join the boys as they make a new friend and strongly consider upgrading the house Nicholas to this newer shiny model, and learn a bit about Burkitt Lymphoma along the way!TIMESTAMPS 0:57 - **** Is Dead 9:52 - The immune system as Starcraft units 11:53 - MYC - The Common Culprit 17:25 - Subtypes of Burkitts 19:23 - The Discovery of EBV 29:04 - Banelings = Spontaneous TLS 35:25 - Histology of Burkitts 37:43 - Flow cytometry for Burkitts 42:47 - Treatment of Burkitts 47:11 - Differentials for Burkitts 49:43 - Take Home Messages Support the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

The Bloody Minded crew hit the road on a tour of Australia’s big things, and this week’s stop is the biggest of them all: the Big Cell. Joining us as tour guide (and DJ, with an all-Phil-Collins playlist) is Dr Jed Kitson, final-year haematology registrar, here to rescue us from a run of indolent lymphomas and talk about the most common aggressive lymphoma in Australia. From R-CHOP to Axi-cel, from Hans to CNS staging, this is a roadtrip you just can't miss.TIMESTAMPS00:56 - The boys take Jed on a roadtrip!02:47 - Who is this Jed?03:36 - What IS DLBCL?05:25 - Classifying DLBCL07:32 - Epidemiology08:42 - Presentation of DLBCL11:03 - Diagnosing DLBCL14:11 - Pathological features on biopsy15:58 - Determining cell of origin (COO)20:03 - DZSig22:38 - Completing the biopsy examination23:39 - BCL2, BCL6 and MYC29:26 - Limitations of FISH30:36 - Workup in new DLBCL33:07 - CNS risk35:17 - Treatment - RCHOP as frontline37:51 - Trying to improve on RCHOP43:53 - CNS prophylaxis45:17 - Assessing treatment response46:04 - Options in relapsed/refractory DLBCL48:00 - Options in late relapse54:00 - Take home messagesSupport the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

As Nick once again leaves Bashar and Cale unsupervised they attend Blood 2026 and speak with the finest Australian and New Zealand haematologists in Auckland. They cover a pot pourri of myeloma, iron replacement, HHT, CAR-T, Cheese and mostly lets be honest, garbage. Thanks to Dr Georgina Calov, Dr Lise Kempler, Dr Miles Ma, Dr Michel Lu, Dr Alison Chandler for putting up with us and we'll resume our scheduled programming as usual. Support the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Look! It’s a follicular lymphoma! No wait, it’s a DLBCL! No wait, it’s a CLL? Actually is it a leukaemia? Join Nick, Cale and Bashar as they wrestle with the morphological and prognostic chameleon that is Mantle Cell Lymphoma. With all the bad bits of an indolent lymphoma and all the bad bits of an aggressive one – as Michael Jackson would say, it's bad (really, really bad). Except when it isn't. Who knows what mantle is doing – we don't think it knows itselfTIMESTAMPS0:57 - Conspiracies 101 3:47 - Epidemiology of MCL 6:41 - Morphology of MCL 7:41 - Flow cytometry for MCL 9:16 - Cyclin D1 14:49 - Risk Stratification for MCL 17:20 - Ki67 - what is it 19:15 - MRD for MCL?! 22:47 - Treatment of MCL 30:52 - Do we need an autoSCT? 33:20 - Leukaemic Non-Nodal MCL 36:27 - Cyclin D1 negative MCL 37:43 - Take Home MessagesSupport the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

What do you call a small B-cell lymphoma that isn't CD5 positive, isn't CD10 positive and generally refuses to wear any of the usual hats? Probably marginal zone lymphoma. Possibly. Maybe.Join the Bloody Minded crew as we head to the edge of the follicle where the bloodstream's customs officers live, and look at what happens when they go rogue. Discover how to cure a cancer with a PPI, and why we're so very bored of the NF-κB pathway.TIMESTAMPS0:57 - Whisky sponsorship pls and thx2:11 - What the marginal zone is/isn't 6:28 - Marginal zone B cells8:35 - Classifying marginal zone lymphoma11:05 - Epidemiology12:09 - Pathophysiology in gastric MALT16:42 - Stimuli for other marginal lymphomas19:55 - Pathological features of marginal21:20 - Splenic MZL25:43 - Flow cytometric features30:13 - Workup of MZL32:20 - Management strategies37:53 - Prognosis38:56 - High grade transformation40:07 - Take home messagesSupport the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Join the boys as they frollickular through the molecular and macro-cular particulars of follicular lymphoma this week. While you're at it, please sign our petition to allow Bashar back into the aquarium and take a gander at Cale's tiny hands.Timestamps00:52 - Bashar is banned from the Aquarium a second time02:13 - Follicular Lymphoma Overview06:07 - Pathophysiology of FL09:50 - Follicular Lymphoma In Situ (Old Name)11:54 - Clinical & Morphology17:24 - Identifying FL in the Lab20:08 - Staging & Workup23:07 - Prognostication25:56 - To treat or not to treat?29:31 - Treating Upfront33:59 - Treating Relapse37:43 - Transformation41:12 - SummarySupport the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Why do haematologists get excited over smudges on a film? What is the deal with that whole IGHV situation? Why is Bashar no longer welcome at the zoo? Join us as we find the answers to these common haematology questions and more in a foray into Chronic Lymphocytic Leukaemia!TIMESTAMPS0:55 - No animals were harmed in the making of this bit 4:13 - Epidemiology of CLL 5:56 - Pathophysiology of CLL 11:42 - MBL 12:36 - SLL 15:54 - Clinical features of CLL 18:18 - Lab features of CLL 20:50 - Flow cytometry for CLL 23:46 - Staging of CLL 25:38 - Prognostication of CLL 27:38 - Indications for treatment in CLL 31:04 - Treatment approaches for CLL 41:53 - Response assessment in CLL 42:49 - Richter's transformation 44:47 - Take Home MessagesSupport the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Welcome to the Land of the Lymphoid. Eighty-odd subtypes, one grid. Help us break our cellular pathways and journey further into our lymphoid season as we ask the only two questions that matter - B or T, fast or slow, forget the platypuses - and build the framework we'll be filling in for the rest of the series. Bring a hat, the savannah is hot. 0:52 - Lymphoid Planet2:50 - Leukaemia vs Lymphoma4:51 - Two Questions & A Recap8:49 - Identifying a Cell16:22 - Indolent vs Aggressive (and Super-Aggressive)22:37 - Indolent B-Cell23:21 - Aggressive B-Cell25:27 - Indolent T-Cell25:44 - Aggressive T-Cell27:42 - Wait... what about Hodgkins31:28 - A Framework32:21 - General Lymphoma Workup38:19 - Staging40:12 - ReviewSupport the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

For the first time, Cale, Nick and Bashar have managed to maintain a contiguous thought across two different episodes and are returning to school - for the basics of immunology. But they’re not going back as teachers, no, the boys are going undercover as a naïve B-cell and following the journey to the lymph node. Will they be shunned to the uncool table like they were in high school? Can they avoid the murderous hunger games of the dark zone. Will they switch classes or somatically hypermutate? Find out on the next episode of 21 Ju… Lymph Node Street.TIMESTAMPS 0:53 - Disguise 101 5:10 - Naive B cells journey 7:56 - Lymph node anatomy refresher 13:31 - Activation of naive B cells 18:50 - Class switching 21:38 - Into the dark zone 24:45 - Diseases at the various stages of maturation 27:18 - Take Home Messages Support the showCheck out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au