104 - Non Hodgkin Lymphoma Flashcards
NHL (Non Hodgkin lymphoma) is a group of cancers of adult __, __, __ cells
B
T
NK
Unlike HL (Hodgkin lymphoma), NHL does not have __ cells and have other biological and clinical characteristics
RS (Reed Sternberg)
The prognosis of NHL __greatly, Unlike HL where the prognosis is __ even under __ only
varies
good
chemotherapy
NHL is __ times more common than HL, and makes up to __% of all new cancers in the US
10
4
NHL is more common in __ __, and the frequency increases with __, especially when > __
white
men
age
40
Patients with __ are more prone to develop __
prone
NHL
__and Burkitt are considered more aggressive and are more common in children
DLBCL
Which infections are correlated with NHL? 7
__- linked with Burkitt and CNS lymphoma
__- linked with T cell lymphoma
__- linked with aggressive B cell
__- linked with gastric MALT
__- linked with cutaneous MALT
__- linked with lymphoplasmacytic and MZL of the spleen
__- linked with HIV lymphoma including Castleman disease
EBV HTLV-1 HIV H. Pylori Borrelia HCV HHV-8
Immunosuppressive patients are linked to NHL due to __
EBV
__% of NHL are __ cells lymphomas
90
B
Physical examination of NHL patients may suggest __ vs __ disease. Look for __ symptoms
aggressive
indolent
B
Important lab workout for NHL include: 5
CBC/chemistry/LFT protein electrophoresis (monoclonal) B-2 microglobulin/LDH LP HBV/HCV/HIV
The recommended imaging modalities for NHL are:
CT-C/A/P- for staging
PET CT- for DLBCL and HL
MRI- for bone/BM/CNS
There are two main groups of NHL: __ which require immediate treatment with chemotherapy and considered treatable, and __ which is treated symptomatically but hard to achieve complete cure
aggressive
indolent
The most common aggressive NHL is __, while the most aggressive is __
DLBCL
Burkitt
The most common indolent NHL is __. Other lymphomas include : 3. __ is considered intermediate between the two groups
FL MZL LPL HCL MCL
Burkitt lymphoma is more common in ___. Biopsy will reveal monotonic infiltration: __ size cells with __ nucleolus, multiple __, and __ cytoplasm. Remember- __
children medium round nuclei basophilic Starry sky
Burkitt lymphoma markers include: 5
BCL2 BCL6 CD10 CD20 CD19
DLBCL is the most common __ cell lymphoma. More common in __, median age of __. Very often associated with __.
B
men
64
EBV
DLBCL contains __ proliferation of __ and __ lymphocytes.
diffuse
large
atypical
DLBCL expresses: 3
CD79a
CD20
CD19
In DLBCL __ is positive in 25-80% of times, and __ in 10%
BCL2
MYC
In DLBCL when both __ and __ are positive- double hit lymphoma
BCL
MYC
DLBCL=__
Diffuse large B-cell lymphoma
What is the first line of treatment for DLBCL?
R-CHOP
rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone
When DLBCL is localized, choose one of two options-
R-CHOP every _ weeks for _ cycles
or
R-CHOP for _ cycles followed by localized __
3
6
3-4
radiation
When DLBCL is advanced- full __
chemotherapy
Another option for DLBCL with mediastinal involvement and double hit (__+__)is- __
MYC+BCL
R-EPOCH
If DLBCL is refractory and/or 2 lines have failed- __
CAR-T
FL=__
Follicular lymphoma
FL is the __ most common NHL preceded by __
2nd
DLBCL
FL has __ organization. To confirm we must look for immunogenic phenotype: 6. Translocation of __ and inappropriate __ are in >85% of cases
follicular
CD6, CD10, CD19, CD20, CD23, BCL6
14:18
BCL2
WHO classifies FL to 3 stages according to number of centroblasts:
I: -
II: -
III: >_
0-5
6-15
15
The typical clinical presentation of FL is of unpainful __, typically in number of sites, even in atypical location such as __
lymphadenopathy
epitrochlear
Asymptomatic FL patient should be __ rather than __
monitored
treated
Treating FL is done with __ alone or in combination with __. ___ is also useful, and patients will usually live for - years
rituximab
chemotherapy
transplantation
15-20
MZL is the second most common __ lymphoma. There are 3 types- __, __, __.
indolent
splenic
extranodular
nodular
__ is a type of MZL, usually in the stomach.
MALT
Lymphocytic lymphoma usually correlates with __. Most patients are diagnosed when in stage __.
IgM
IV
Lymphocytic lymphoma with high IgM are referred to as- __, and may suffer from __ symptoms. __ mutation is found in __% of cases. __ is used when hypercoagulability is present
Waldenstorm macroglobulinemia hypercoagulability MYD88 90 plasmapheresis
Lymphocytic lymphoma is treated with __, and when refractory- consider __ inhibitor, __ and oral __.
rituximab
mTOR
Everolimus
BTK
MCL (__), is an intermediate lymphoma, between indolent and aggressive. Median survival is - years
Mantle cell lymphoma
5-10
MCL variant __ is more indolent, while __ is more aggressive
SOX11 (splenomegaly)
Blast (high Ki67)
Mycosis fungoides is a __ cell lymphoma, known as __, with a median age of __
T
cutaneous
50
In mycosis fungoides, __ continues to __ and from there to __. When continues to general erythroderma (widespread reddening of the skin) and tumor cells in circulation- __ syndrome
patch
plaque
tumors
Sézary
PTCL (__) involve the __, __, __, and __. Prognosis of __ years survival
Peripheral T-cell lymphoma BM liver spleen skin 2
PTCL will usually have positive __ and __. Treatment is usually with __
CD3
CD4
CHOP
Other T cells NHL include: AITL (\_\_) ALCL (\_\_) ATLL (\_\_) Extranodal NK/T cell lymphoma- \_\_ type ()
angioimmunoblastic T-cell lymphoma- hyperglobulinemia
anaplastic large cell lymphoma- more in children
adult T-cell leukemia/lymphoma- more in japan- HTLV-1
nasal type- associated with EBV
