DLBCL Flashcards
staging/workup
CBC, CMP, baseline LDH and uric acid (TLS), HIV, hep panel
PET/CT
Bone marrow biopsy
TTE
standard treatment for DLBCL
R-CHOP chemotherapy followed by radiation to bulky areas
management of CNS involvement
high dose systemic methotrexate
RF’s for TLS
stage III/IV disease, bulky disease, elevated LDH at baseline, decreased renal function
management of positive area on PET/CT in response assessment
Biopsy (frequent false positives)
rituximab caveat
can lead to reactivation of hep b in patients infected with hepatitis b
management of hep B positive rituximab patient
antiviral prophylaxis
What does double hit refer to?
MYC and BCL2 genes or MYC and BCL6 genes
Clinical implication of double hit lymphoma
Associated with advanced disease that spreads to the central nervous system
Response assessment
PET/CT
Prevalence (relatively)
second most common NHL
Gender predominance
Male (like most NHLs)
Testing required before starting Anti-CD20/rituxan
Test for HBV
Recommendation for patients at high risk of HBV reactivation
NRTI’s (entecavir or tenofovir)
Management of patient who is HBV surface antigen negative and core antibody positive
- Start antiviral therapy (can still have reactivation)
Surveillance
Symptom based
*No utility of CT scans in asymptomatic patients
term for a malignancy that lights up on PET CT
“FDG-avid” tumor
prognostic significance of germinal center DLBCL
- good prognosis following standard therapy with R-CHOP
prognostic significance of activated b cell DLBCL
- high relapse rates, less favorable prognosis
management of double hit DLBCL
induction therapy with da-EPOCH-R
clinical features of primary large b cell lymphoma of the mediastinum
- aggressive tumor arising in mediastinum from thymic b cell. Patients have a locally invasive anterior mediastinal mass that often extends into local structures.
RFs for CNS involvement
- extranodal site involvement
- high LDH
- age over 60
- RP nodal involvement
- concurrent bone marrow involvement
Definition of advanced stage DLBCL
cannot be contained within 1 irradiation field
Rituxan administration in RCHOP
375 mg on day 1 of each cycle
RCHOP — when each drug is given
All drugs are given on day 1, prednisone is given on days 1 through 5
emetic risk of RCHOP
moderate or high?
doxorubicin contraindication (Ejection fraction threshold)
EF less than 30%
What is double expressor DLBCL
MYC expression and BCL2 expression
ABC subtype stands for
Activated B cell
Role for maintenance therapy in DLBCL?
No well defined role for maintenance therapy
bulky disease defined as
adenopathy greater than 10 cm
Stage I-II, nonbulky management
R-CHOP x 3 cycles, consider XRT to bulky areas
Preferred regimen for double hit
DA-EPOCH-R favored at UMASS
clinical significance of double expressor
Milder phenotype BUT higher rates of CNS involvement
Factors involved in IPI risk score for DLBCL
- age over 60
- performance status 2 or higher
- greater than 1 extranodal site
- stage III or IV
- elevated LDH
relapsed refractory management
IF chemo-sensitive + disease free interval greater than 1 year from initial treatment, R-ICE x 2 cycles, then autologous HSCT
Molecular subtypes
Activated B cell (ABC)
Germinal center B cell (GCB)
Standard second line for DLBCL
IF chemo-sensitive + disease free interval greater than 1 year from initial treatment, platinum-based chemotherapy R-ICE x 2 cycles, then autologous HSCT
Han’s algorithm for differentiating germinal center b cell subtype vs. Non-GCB includes what?
CD10
BCL6
IRF4 (MUM1)
ABC subtype associated with which type
Double expressor
