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Hematology, oncology > DLBCL > Flashcards

DLBCL Flashcards

1
Q

staging/workup

A

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

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2
Q

standard treatment for DLBCL

A

R-CHOP chemotherapy followed by radiation to bulky areas

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3
Q

management of CNS involvement

A

high dose systemic methotrexate

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4
Q

RF’s for TLS

A

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

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5
Q

management of positive area on PET/CT in response assessment

A

Biopsy (frequent false positives)

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6
Q

rituximab caveat

A

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

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7
Q

management of hep B positive rituximab patient

A

antiviral prophylaxis

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8
Q

What does double hit refer to?

A

MYC and BCL2 genes or MYC and BCL6 genes

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9
Q

Clinical implication of double hit lymphoma

A

Associated with advanced disease that spreads to the central nervous system

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10
Q

Response assessment

A

PET/CT

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11
Q

Prevalence (relatively)

A

second most common NHL

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12
Q

Gender predominance

A

Male (like most NHLs)

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13
Q

Testing required before starting Anti-CD20/rituxan

A

Test for HBV

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14
Q

Recommendation for patients at high risk of HBV reactivation

A

NRTI’s (entecavir or tenofovir)

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15
Q

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

A
  • Start antiviral therapy (can still have reactivation)
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16
Q

Surveillance

A

Symptom based

*No utility of CT scans in asymptomatic patients

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17
Q

term for a malignancy that lights up on PET CT

A

“FDG-avid” tumor

18
Q

prognostic significance of germinal center DLBCL

A
  • good prognosis following standard therapy with R-CHOP
19
Q

prognostic significance of activated b cell DLBCL

A
  • high relapse rates, less favorable prognosis
20
Q

management of double hit DLBCL

A

induction therapy with da-EPOCH-R

21
Q

clinical features of primary large b cell lymphoma of the mediastinum

A
  • aggressive tumor arising in mediastinum from thymic b cell. Patients have a locally invasive anterior mediastinal mass that often extends into local structures.
22
Q

RFs for CNS involvement

A
  • extranodal site involvement
  • high LDH
  • age over 60
  • RP nodal involvement
  • concurrent bone marrow involvement
23
Q

Definition of advanced stage DLBCL

A

cannot be contained within 1 irradiation field

24
Q

Rituxan administration in RCHOP

A

375 mg on day 1 of each cycle

25
Q

RCHOP — when each drug is given

A

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

26
Q

emetic risk of RCHOP

A

moderate or high?

27
Q

doxorubicin contraindication (Ejection fraction threshold)

A

EF less than 30%

28
Q

What is double expressor DLBCL

A

MYC expression and BCL2 expression

29
Q

ABC subtype stands for

A

Activated B cell

30
Q

Role for maintenance therapy in DLBCL?

A

No well defined role for maintenance therapy

31
Q

bulky disease defined as

A

adenopathy greater than 10 cm

32
Q

Stage I-II, nonbulky management

A

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

33
Q

Preferred regimen for double hit

A

DA-EPOCH-R favored at UMASS

34
Q

clinical significance of double expressor

A

Milder phenotype BUT higher rates of CNS involvement

35
Q

Factors involved in IPI risk score for DLBCL

A
  • age over 60
  • performance status 2 or higher
  • greater than 1 extranodal site
  • stage III or IV
  • elevated LDH
36
Q

relapsed refractory management

A

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

37
Q

Molecular subtypes

A

Activated B cell (ABC)

Germinal center B cell (GCB)

38
Q

Standard second line for DLBCL

A

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

39
Q

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

A

CD10
BCL6
IRF4 (MUM1)

40
Q

ABC subtype associated with which type

A

Double expressor

41
Q
A

Hematology, oncology (218 decks)

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