DLBCL

Question 1

What prognostic tool is used and what are the risk factors contributing to the score?

Answer 1

International prognostic index

Age >60y
PS 2-4
Stage III - IV
Elevated LDH
>1 extranodal site

Question 2

What is a double or triple hit lymphoma?

Answer 2

5-10% have MYC rearrangement (confers poor prognosis), additionally may have BCL2 or BCL6 rearrangement (double or triple hit), med survival <12m

Question 3

What percentage have bone marrow involvement?

Answer 3

10%

Question 4

What % patients have primary refractory disease?

Answer 4

10-15%

Further 20-30% relapse

Question 5

What is classed as bulky disease?

Answer 5

> 7.5cm

Question 6

What is the standard management of stage 1A with no bulk or significant risk factors?

Answer 6

3 x R-CHOP & 30Gy/15# XRT

Question 7

What is the standard treatment of Stage II - IV?

Answer 7

6 x R-CHOP with 30Gy/15# XRT to site of previous bulk or residual

Question 8

Who would you consider CNS prophylaxis in?

Answer 8

Stage IV, 
>1 extranodal site, 
testicular,
Breast
Epidural space

Question 9

What regimen could be used if cardiac CI to doxorubicin?

Answer 9

R-CVP or R-GCVP

Question 10

Describe the R-CHOP regimen

Answer 10

Rituximab 375mg/m2 IV D1
Cyclophosphamide 750mg/m2 IV D1
Doxorubicin 50mg/m2 IV D1
Vincristine 1.4mg/m2 IV D1 (max 2mg)
Prednisolone 100mg D1-5

Q21d

Question 11

Describe the R-CVP regimen

Answer 11

Rituximab 375mg/m2 IV D1
Cyclophosphamide 750mg/m2 IV D1
Vincristine 1.4mg/m2 IV D1 (max 2mg)
Prednisolone 100mg PO D1-5

Q21d

Question 12

Describe the treatment for testicular lymphoma

Answer 12

Propensity for CNS involvement
6x R-CHOP with prophylactic intrathecal MTX with cycles 1-4
2-3 cycles high dose MTX following completion
XRT to contra lateral testis and XRT to sites of bulky disease