DLBCL and Burkitt Lymphoma Flashcards
What are the 5 components to the IPI for DLBCL?
Age >60
LDH above ULN
ECOG 2+
Stage III or IV
Extranodal sites >1
(PALES: Performance, Age, LDH, Extranodal, Stage)
CD10+ helps distinguish what types of DLBCL?
Germinal center type is Cd10+
What is short course R-CHOP and who is eligible for it?
R-CHOP x4 followed by Rx2 (instead of R-CHOPx6)
Stage I/II, non-bulky, low risk (IPI =0)
MoA of Polatuzumab vedotin
ADC targeting CD79b
Conjugated to microtubule inhibitor
Pola-R-CHP is better than R-CHOP in what patients?
ABC subtype
High IPI
Age >60
Not bulky
–No change in OS or CR
Treatment for primary mediastinal large B cell lymphoma
DA-R-EPOCH
What are the genetic aberrations in double hit lymphoma?
MYC
BCL2
What are the genetic aberrations in triple hit lymphoma?
MYC
BCL2
BCL6
Treatment for double or triple hit lymphoma?
DA-R-EPOCH
What is the difference in GCB and ABC lymphoma in those with HIV or immunodeficiencies?
ABC has much worse prognosis, tend to be more immunosuppressed
Treatment for HIV-associated DLBCL
R-EPOCH
Ritux only when CD4>50
In HIV-associated DLBCL, when can you give Rituximab?
CD4 >50
What two lymphomas are commonly HHV8+
Primary effusion lymphoma
Multicentric Castlemans
Treatment for localized testicular primary LBCL?
Orchiectomy plus XRT to contralateral testes
Consider CNS prophylaxis
What work-up is needed after someone is diagnosed with primary CNS lymphoma?
Testicular US
Slit lamp exam
Spine MRI
BMBx
1L treatment for advanced DLBCL (2)
R-CHOP
Pola-R-CHP
In R/R DLBCL, how does the time from 1L therapy change the treatment algorithm?
If less than a year, than you determine eligibility for CAR-T
If more than 1 year, then determine eligibility for autoHCT
R/R LBCL for fit patient who relapsed after less than 1 year after 1L? (2)
CAR-T
Axi-cel
Liso-cel
Treatment for R/R LBCL in a fit patient who relapsed more than 1 year from 1L treatment.
Salvage chemo then autoHCT
R/R LBCL treatment in patient relapsed more than 1 year from 1L treatment and you want to bring them to ASCT.
R+Chemo
RICE, R-GemOx, RGDP, R-DHAP, R-ESHAP
CAR-T treatment options in 3L or later in DLBCL?
Axicaptagene
Tisaleucel
Lisocaptagene
Chemotherapy-free regimens in R/R LBCL (3)
Pola-Benda-R
Tafasitumab - Len
Loncastuximab
Two BiTE options for R/R LBCL
Glofitimab
Epcoritimab
Best treatment strategy for fit patient with R/R LBCL after ASCT?
CAR-T
Treatment for R/R DLBCL in unfit patient who isn’t a candidate for CAR-T or ASCT? (4)
Tafasitumab + Len
Lonca-T
Glofitimab
Epcoritimab
Classic translocation in Burkitt lymphoma
t(8;14)
African endemic Burkitt lymphoma is associated with what disease?
EBV
IMmunophenotype of BUrkitt
CD19+, Cd20+, CD10+, BCL6+
TdT negative
Ki67 100%
Never expresses Bcl2
3 most common translocations in Burkitt lymphoma
8;14
8;22
2;8
What gene translocation is classic in Burkitt?
MYC
Treatment options for 1L Burkitt lymphoma (3)
R-HyperCVAD
DA-EPOCH-R
CODOX-M-IVAC
How to calculate a CNS IPI
Age >60
PS >1
Extranodal involvement >1
LDH >ULN
Stage III or IV
Kidney or adrenal involvement
(IPI + kidney/adrenal involvement)
What CNS IPI score should be treated with CNS prophylaxis?
4-6
CNS prophylaxis options for high-risk patients (2)
IT MTX (or cytarabine)
High dose MTX
What four types of lymphoma are at high risk of CNS invovlement?
Testicular
Kidney/adrenal
Primary cutaneous DLBCL, leg type
Stage IE DLBCL of breast
Preferred treatment for AIDS related plasmablactic lymphoma? (3)
EPOCH
CODOX-M/IVAC
HyperCVAD
Treatment of stage I/II DLBCL with non-bulky disease?
R-CHOP x3, then PET-CT. If CR, then ISRT or 1 more RCHOP
Treatment of stage I/II DLBCL with bulky disease?
R-CHOP x3-4 cycles, then PET. If CR, then R-CHOP x2-3 more +/- ISRT
Treatment for R/R Primary mediastinal B cell lymphoma? (3)
Pembro
Nivo +/- Bv
Or like DLBCL - RICE–>Auto or CAR=T
1L treatment for primary mediastinal B-cell lymphoma? (2)
DA-R-EPOCH
RCHOP
