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)
