21. non-Hodgkin lymphomas

Question 1

what patients are predisposed to develop NHL?

Answer 1

both primary and secondary immunodeficiencies

Question 2

how is mycosis fungoides that progresses to T-cell leukemia called?

Answer 2

Sezary syndrome

mycosis fungoides is a cutaneous T-cell lymphoma (skin patches and plaques)

Question 3

marginal zone lymphoma is associated with?

Answer 3

chronic inflammation (Sjogren syndrome, chronic gastritis, Hashimoto’s thyroiditis)

Question 3

marginal zone lymphoma is associated with?

Answer 3

chronic inflammation (Sjogren syndrome, chronic gastritis, Hashimoto’s thyroiditis)

Question 4

how to distinguish between primary CNS lymphoma and toxoplasmosis (both are seen as ring enhancing lesions on MRI)

Answer 4

CSF analysis

Question 5

CD5+ malignant cells are seen in?

Answer 5

Mantle cell lymphoma

Question 6

what imaging is best for staging in NHL?

Answer 6

PET-CT

Question 7

management of relapsing NHL disease

Answer 7

high dose chemo +HSCT

before and after chemo: radiation therapy is given to previous disease sites

Question 8

management of indolent NHL

Answer 8

Symptomatic (bulky disease, cytopenia, B symptoms)

1. radiation for localized disease
2. Rituximab +/- chemo
3. single-agent chemotherapy

Question 9

management of aggressive NHL

Answer 9

1. CHOP-R (cyclophosphamide, hydroxydaunorubicin, oncovorin, prednisone, rituximab)
2. radiation for localized or bulky disease

*consider CNS prophylaxis with intrathecal or systemic high dose methotrexate

Question 10

management of highly- aggressive NHL

Answer 10

low risk–> CODOX-M
high risk–> CODOX-M/IVAC

*all patients should receive CNS prophylaxis and tumor lysis syndrome

Question 11

how is low/high risk patients with highly aggressive NHL defined?

Answer 11

low risk- normal LDH levels and single disease focus of < 10cm
all others are high risk

Question 12

what is important to check before giving rituximab in NHL?

Answer 12

HBsAg and anti-HBc (may cause HBV reactivation)

Question 13

what is considered a “bulky disease” ?

Answer 13

a single nodal mass of 10 cm or greater than 1/3 of the transthoracic diameter at any level of thoracic vertebrae as determined by CT

Question 14

what tests should be done in complete remission?

Answer 14

PET-CT should be done to confirm CR

• clinical follow up every 3-6 months for 5 years, and then yearly or as clinically indicated
• CT scan every 6 months for 2 years after completing treatment, and then only clinically indicated