Background and treatment Flashcards
How is grade I defined under a microscope?
5 or less centroblasts under HPF
How is grade II defined under a microscope?
6 to 15 centroblasts under HPF
How is grade III defined under a microscope?
More than 15 centroblasts under HPF + centrocytes (IIIa)
More than 15 centroblasts under HPF, solid sheets of centroblasts (IIIb)
What markers are follicular lymphoma cells positive for? And negatve for?
Positive for
- CD19
- CD20
- CD21
- CD10
- BCL-6
Negative for CD5 and CD43
What is the most common genetic marker for follicular lymphoma?
t(14:18) which is a mutation that upregulates bcl-2
Most common symptom of disease?
- Painless, peripheral adenopathy in the cervical, axillary, inguinal and femoral regions
How often is the spleen, liver or BM involved with FL at dx?
- Spleen 40%
- Liver 50%
- BM 60-70%
FLIPI factors
- Stage III/IV
- LDH > normal
- Age > 60
- No of nodal sites > 4
- Hgb < 12
What is the 5 year OS for patients with increasing FLIPI scores?
0-1 - 91%
2 - 78%
3 -5 - 52%
What dose is recommended for Stage I-II Grade I FL?
24 Gy at 2 Gy per fraction
What are NCCN supported indications for treatment of follicular lymphoma patients Staged II (bulky), III-IV?
- Symptoms
- Threatened end organ damage
- Cytopenia secondary to lymphoma
- Bulky disease
- Steady progression
- Patient preference
What RT dose should be used palliatively for FL patients with Stage III-IV disease?
2 Gy x 2 fractions
When is a BM bx recommended for work up?
All cases
What remains the standard treatment for localized low-grade follicular lymphoma?
Locoregional RT to 24 or 30
36 Gy if bulky
What labs are needed for FL patients at diagnosis (NCCN)?
- LDH
- CBC
- B2 microglobulin
- CMP
- Hepatitis B
- Pregnancy testing for women of child bearing age
What tumor specific genetic mutations are common among FL patients?
t(14:18) - 80-90%
t(2:18) and t(18:22)
What imaging is indicated for patients at diagnosis (NCCN)?
- Diagnostic CT scan of the N/C/A/P
- PET/CT scan
- MUGA Scan if doxorubibin is being considered
What are NCCN supported first line therapy for patients with Stage III-IV?
- Bendamustine+rituximab
- RCHOP
- RCVP
- Rituximab
RT 2-30 Gy if needed for bulky or symptomatic disease
What are NCCN supported first line therapies for Elderly or Infirm with Stage III-IV disease?
- Radioimmunotherapy
- Rituximab
- Single Alkylators (chlorambucil or cyclophosphamide) +/-rituximab
RT 2-30 Gy if needed for bulky or symptomatic disease
Median Age?
60
F:M ratio
1.7:1
What percentage of patients have B symptoms at diagnosis?
20%
What is the definition of bulky disease?
It varies. It can be greater than 5 cm or greater than 10 cm.
How often does transformation to DLBCL occur in patients with Stage I disease?
10-15%
What is the 10 year DFS for Stage I-II treated with RT?
40-50%
What is the median OS for all patients?
- Median OS: 8-9 years
- if < 60: 12 years
What is the first line chemotherapy for Stage III-IV disease?
- Rituxan: 375 mg/m2 IV q4 weeks
- Bendamustine: 90 mg/m2 on day 1 and 2 4 weeks
