3.27 WEIR Lymphomas II

Question 1

What 4 major factors must a doctor consider when he/she decides if cure is possible for a patient with lymphoma?

Answer 1

Tumor Histology

Tumor Stage

Condition of patient

Avaliable Therapies

Question 2

Name the most common indolent lymphoma. Aggressive lymphoma?

Answer 2

Indolent: Follicular lymhoma

Aggressive: Diffuse Large B cell lymphoma

Very Aggressive: Burkitt’s (t(8;14))

Question 3

Be able to stage a patient with lymphoma

Answer 3

-Stage I: single node or lymphoid structure

–Stage IE: extranodal is the sole site of involvment

• Stage II: Two or more lymph regions one side diaphragm
• Stage III: both sides of diaphragm

Stage IV: Lymph node involvement plus an extranodal site of involvement

How to stage: history and exam, CAT scan chest, abdomen and pelvis, BM aspirate and biopsy w/ flow, Gallium or PET scan, Chemistries: CBC, LDH and CSF is high risk disease

Question 4

What are the major treatment decision differences between indolent and aggressive lymphomas?

Answer 4

Indolent: (1) Higher stage (2) Slower progression (3) Response to simple therapies (4) incurable except with stage 1-2 (allogenic transplant may cure) (5) survival independent of early treatment (6) treat when symptomatic

Aggressive: (1) often lower stage (2) rapid progression (3) requires complex therpies (4) potential cure** (5) early therapy required, treat right away

Question 5

Understand the mechanism and sites of action of rituximab and ibrutinib.

Answer 5

Rituximab: CD20: increased survival when added to CHOP

Ibrutinib: Bruton Tyrosine Kinase Inhibitior (Bcell Refractory disease)

-Prevents Kinase to eventual activation of NFkB which will induce transcription of survival signals to avoid apoptosis

Other drugs mentioned:

Alemtuzumab (CD52, CLL and T-cell leukemia)

Brentuximab vedatin: CD30 (Hodgkin and CD30+ T cell lymphomas)

Inotuzumab ozogamicin: CD22

Question 6

What is the name of the most common cutaneous lymphoma and what cell can you find in the blood in some of these patients?

Answer 6

Mycosis Fungoides

-T cell derived (usually indolent)

Stage 4: seizry syndrome

Question 7

What is a common complication of radiation therapy in young Hodgkin’s Disease women?

Answer 7

• They are at an increased risk for breast cancer w/n 30yrs of treatment, some showing up as early as 15 yrs
• Reconsidering chemo therapy for these patient

Question 8

Name two complications of CLL.

Answer 8

• Hypogammaglobulinemia: reoccuring infections
• Autoimmune cytopenias
• Anemia
• Splenomegaly
• Lymphadenopathy
• Lymphocytosis
• Often asymptomatic

Question 9

Name two poor prognostic chromosome abnormalities in CLL.

Answer 9

• High Stage
• Increased lymphocyte doubling time
• Deletion 17p, 11q23 (p53)
• Unmutated VH gene, ZAP-70, CD38

Question 10

When is BMT used in Lymphomas?

Answer 10

• Indolent lymphomas that are stage I or II
• Aggressive lymphomas that relapse