DLBCL

Question 1

staging/workup

Answer 1

CBC, CMP, baseline LDH and uric acid (TLS), HIV, hep panel
PET/CT
Bone marrow biopsy
TTE

Question 2

standard treatment for DLBCL

Answer 2

R-CHOP chemotherapy followed by radiation to bulky areas

Question 3

management of CNS involvement

Answer 3

high dose systemic methotrexate

Question 4

RF’s for TLS

Answer 4

stage III/IV disease, bulky disease, elevated LDH at baseline, decreased renal function

Question 5

management of positive area on PET/CT in response assessment

Answer 5

Biopsy (frequent false positives)

Question 6

rituximab caveat

Answer 6

can lead to reactivation of hep b in patients infected with hepatitis b

Question 7

management of hep B positive rituximab patient

Answer 7

antiviral prophylaxis

Question 8

What does double hit refer to?

Answer 8

MYC and BCL2 genes or MYC and BCL6 genes

Question 9

Clinical implication of double hit lymphoma

Answer 9

Associated with advanced disease that spreads to the central nervous system

Question 10

Response assessment

Answer 10

PET/CT

Question 11

Prevalence (relatively)

Answer 11

second most common NHL

Question 12

Gender predominance

Answer 12

Male (like most NHLs)

Question 13

Testing required before starting Anti-CD20/rituxan

Answer 13

Test for HBV

Question 14

Recommendation for patients at high risk of HBV reactivation

Answer 14

NRTI’s (entecavir or tenofovir)

Question 15

Management of patient who is HBV surface antigen negative and core antibody positive

Answer 15

• Start antiviral therapy (can still have reactivation)

Question 16

Surveillance

Answer 16

Symptom based

*No utility of CT scans in asymptomatic patients

Question 17

term for a malignancy that lights up on PET CT

Answer 17

“FDG-avid” tumor

Question 18

prognostic significance of germinal center DLBCL

Answer 18

• good prognosis following standard therapy with R-CHOP

Question 19

prognostic significance of activated b cell DLBCL

Answer 19

• high relapse rates, less favorable prognosis

Question 20

management of double hit DLBCL

Answer 20

induction therapy with da-EPOCH-R

Question 21

clinical features of primary large b cell lymphoma of the mediastinum

Answer 21

• aggressive tumor arising in mediastinum from thymic b cell. Patients have a locally invasive anterior mediastinal mass that often extends into local structures.

Question 22

RFs for CNS involvement

Answer 22

• extranodal site involvement
• high LDH
• age over 60
• RP nodal involvement
• concurrent bone marrow involvement

Question 23

Definition of advanced stage DLBCL

Answer 23

cannot be contained within 1 irradiation field

Question 24

Rituxan administration in RCHOP

Answer 24

375 mg on day 1 of each cycle

Question 25

RCHOP — when each drug is given

Answer 25

All drugs are given on day 1, prednisone is given on days 1 through 5

Question 26

emetic risk of RCHOP

Answer 26

moderate or high?

Question 27

doxorubicin contraindication (Ejection fraction threshold)

Answer 27

EF less than 30%

Question 28

What is double expressor DLBCL

Answer 28

MYC expression and BCL2 expression

Question 29

ABC subtype stands for

Answer 29

Activated B cell

Question 30

Role for maintenance therapy in DLBCL?

Answer 30

No well defined role for maintenance therapy

Question 31

bulky disease defined as

Answer 31

adenopathy greater than 10 cm

Question 32

Stage I-II, nonbulky management

Answer 32

R-CHOP x 3 cycles, consider XRT to bulky areas

Question 33

Preferred regimen for double hit

Answer 33

DA-EPOCH-R favored at UMASS

Question 34

clinical significance of double expressor

Answer 34

Milder phenotype BUT higher rates of CNS involvement

Question 35

Factors involved in IPI risk score for DLBCL

Answer 35

- age over 60 - performance status 2 or higher - greater than 1 extranodal site - stage III or IV - elevated LDH

Question 36

relapsed refractory management

Answer 36

IF chemo-sensitive + disease free interval greater than 1 year from initial treatment, R-ICE x 2 cycles, then autologous HSCT

Question 37

Molecular subtypes

Answer 37

Activated B cell (ABC) | Germinal center B cell (GCB)

Question 38

Standard second line for DLBCL

Answer 38

IF chemo-sensitive + disease free interval greater than 1 year from initial treatment, platinum-based chemotherapy R-ICE x 2 cycles, then autologous HSCT

Question 39

Han's algorithm for differentiating germinal center b cell subtype vs. Non-GCB includes what?

Answer 39

CD10 BCL6 IRF4 (MUM1)

Question 40

ABC subtype associated with which type

Answer 40

Double expressor