Clinical Lymphoma Flashcards
Systemic manifestations of lymphoma include ___ (aka “B symptoms)
Local manifestations of lymphoma include __and __ (manifests as early satiety)
Systemic manifestations of lymphoma include fever, night sweats, unintentional weight loss, anorexia, pruritis
Local manifestations of lymphoma include lymphadenopathy and splenomegaly (manifests as early satiety)
T/F: You never do a fine needle aspiration to diagnose lymphoma
True. FNA doesn’t preserve the lymph node architecture such that a definitive diagnosis can’t be made.
**Dx is done with:
Excisional biopsy >> demonstrates nodal architecture
Immunohistochemistry >> confirm lymphoid origin of cells/demonstrate clonality with kappa/lambda staining
Flow cytometry
Lymphoma can be staged using the Ann Arbor staging system. Describe the different stages 1 thru 4
Stage I: one lymph node above or below the diaphragm
Stage II: two lymph nodes on either side of the diaphragm (either above or below)
Stage III: lymph nodes above and below the diaphgram
Stage IV: extranodal involvement
Patients with Hodgkin’s lymphoma can have painless lymphadenopathy, characteristic ___ and ___ (with alcohol consumption)
Patients with Hodgkin’s lymphoma can have painless lymphadenopathy, characteristic pruritis (due to cytokine release) and severe pain (with alcohol consumption) - due to vasodilation within lymph node capsule
Treatment of Hodgkin lymphoma consists of the ABVD regimen +/- radiation. Which drugs are part of this regimen?
Adriamycin
Bleomycin
Vinblastine
Dacarbazine
What are the side effects of the ABVD drugs?
Adriamycin (aka Doxorubicin) >> cardiotoxicity
Bleomycin >> pulmonary fibrosis
Vinblastine >> severe bone marrow suppression (+ neuropathy but that’s more the other drug)
Da carbizine >> da cytopenias
For relapsed disease, pts with Hodgkin Lymphoma can be given salvage chemotherapy (which does what?), ___ (a new mAb) and immunotherapy targeting ___ in Reed-Sternberg cells
For relapsed disease, pts with Hodgkin Lymphoma can be given salvage chemotherapy (which resuces pt from effects of chemo), Brentuximab (a new mAb) and immunotherapy targeting PD-L1 in Reed-Sternberg cells
Brentuximab targets ___ which is expressed on the surface of Reed-Sternberg cells. The antibody is conjugated to a chemo agent ___ which directly targets ___ cells
Brentuximab targets CD30 which is expressed on the surface of Reed-Sternberg cells. The antibody is conjugated to a chemo agent (MMAE) which directly targets CD30+ cells
Diffuse large B cell lymphoma often presents as a bulky tumor mass, ___ and presence of ___ symptoms. DLBCL also expresses what CD markers? (hint: its the usual for B cell cancers + a new one in this lecture)
Diffuse large B cell lymphoma often presents as a bulky tumor mass, extranodal disease and presence of B symptoms. DLBCL also expresses CD19, CD20 and CD79a
The treatment of DLBCL is ___ (hint: the acronym doesn’t match with the letters)
Rx for DLBCL is R-CHOP:
- Rituximab
- Cyclophosphamide
- Dox- HO -rubicin
- Vincristine (vin-cristOned)
- Prednisone
What are the side effects of the R-CHOP drugs?
Rituximab (anti-CD20; can cause tumor lysis syndrome/cytokine release syndrome/myelosuppression/infection)
Cyclophosphamide >> cytopenias
Doxorubicin >> cardiotoxicity, alopecia
Vincristine >> neuropathy
Prednisone
Patients with HIV, adrenal/kidney/testicular/breast involvement with DLBCL usually get ___ in addition to systemic therapy
Patients with HIV, adrenal/kidney/testicular/breast involvement with DLBCL usually get prophylactic intrathecal chemotherapy in addition to systemic therapy
A novel therapy for DLBCL involves the use of CAR-T therapy. What are 2 side effects of this therapy?
Cytokine release syndrome
Neurotoxicity
Primary mediastinal large B-cell lymphoma is a subset of DLBCL that presents with ___ typically in young female patients. What is the Rx of this disease?
Primary mediastinal large B-cell lymphoma is a subset of DLBCL that presents with large mediastinal mass typically in young female patients. (comes from thymic medullary B cells)
Rx = infusion chemotherapy sans radiation due to long term side effects
Burkitt lymphoma has a high incidence of __ and can be treated with ___
Burkitt lymphoma has a high incidence of tumor lysis syndrome and can be treated with infusional chemotherapy
Follicular lymphoma is incurable so Rx is to manage the disease. Two treatment regimens for FL are ___ and ___ (hint: both involve rituximab)
Follicular lymphoma is incurable so Rx is to manage the disease. Two treatment regimens for FL are bendamustine + rituximab, and rituximab + revlimid
For relapsed follicular lymphoma, pts get targeted therapy in the form of ___
PI3K inhibitors
An absolute lymphocyte count over ___ is indicative of CLL
An absolute lymphocyte count over >5000 is indicative of CLL
For CLL/SLL, the presence of ___ (genetic abnormality) indicates high risk, aggressive disease
For CLL/SLL, the presence of del(17p) involving p53 indicates high risk, aggressive disease
CLL/SLL uses a disctint Rai staging system. Describe the *technically* 5 stages of this system
Stage 0 – only peripheral blood leukocytosis
Stage I – lymphocytosis + lymphadenopathy
Stage II – lymphocytosis + hepatosplenomegaly
Stage III – Lymphocytosis + anemia
Stage IV – lymphocytosis + thrombocytopenia
In general, CLL/SLL can be treated with chemotherapy or targeted therapy.
The FCR regimen (fludarabine, cyclophosphamide and rituximab) is given to __ patients while the BR regimen (___ + ___) is given to older pts
In general, CLL/SLL can be treated with chemotherapy or targeted therapy.
The FCR regimen (fludarabine, cyclophosphamide and rituximab) is given to younger patients while the BR regimen (bendamustine + rituximab) is given to older pts
Targeted therapy can also be used to treat CLL/SLL. What are 3 drugs used to treat this and what do they do?
Ibrutinib >> Bruton’s tyrosine kinase (BTK) inhibitor
Idelalisib >> PI3K inhibitor
Venetoclax >> BCL2 inhibitor
Splenic marginal zone lymphoma presents with very bad ___ and is strongly ass’d with ___ infection (hint: its one of the Hepatitis viruses)
MALT lymphoma is ass’d with H pylori and ___ infection (leads to ocular adnexa – basically a lymphoma behind the eye)
Splenic marginal zone lymphoma presents with very bad splenomegaly and is strongly ass’d with Hep C infection
MALT lymphoma is ass’d with H pylori and C psittaci infection (leads to ocular adnexa – basically a lymphoma behind the eye)
**for H pylori mediated MALT lymphoma, can also give Rituximab as an alt to antibiotics**
Which T cell NHL is associated with HTLV-1 infection and commonly presents with visceral involvement, hypercalcemia, skin lesions, osseous involvement?
Adult T-cell leukemia/lymphoma (T-ALL)
___ (lymphoma type) is ass’d with EBV infection and commonly involves the nasopharynx
Extranodal NK/T-cell lymphoma is ass’d with EBV infection and commonly involves the nasopharynx
Anaplastic large T cell lymphoma (type of T cell NHL) is characterized by ___ involvement + ___ translocation
Anaplastic large T cell lymphoma (type of T cell NHL) is characterized by visceral involvement + ALK t(2;5) translocation
Rx is with brentuximab (anti-CD30) and CHP chemo
Peripheral T cell lymphoma not otherwise specified is a group of heterogeneous diseases that can be treated w/ ___
Peripheral T cell lymphoma not otherwise specified is a group of heterogeneous diseases that can be treated w/ CHOP chemo (note that there’s no R here because that’s for the B cells and this is a T cell disorder)
___ is a malignant T cell infiltration of the skin. Rx involves topical or phototherapy or retinoid therapy with ___
Mycosis fungoides is a malignant T cell infiltration of the skin. Rx involves topical or phototherapy or retinoid therapy with Bexarotene
___ is characterized by circulating mycosis fungoides cells in the blood and can be treated with Mogamulizumab
Sezary syndrome is characterized by circulating mycosis fungoides cells in the blood and can be treated with Mogamulizumab (anti-CCR4 antibody)
