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Erez's HEM TEST notes 2024 > DLBCL facts > Flashcards

DLBCL facts Flashcards

1
Q

Immunophenotype of DLBCL

A

CD20, CD19, CD79a
GCB- CD10 + , Bcl6 +
Non GCB- CD10-, MUM1 +

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2
Q

IPI DLBCL

A

LDH
Age 60
ECOG
Advanced stage
> 1 extranodal site

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3
Q

Sensitivity of Hans criteria in DLBCL

A

70-80%
Should not determine Tx

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4
Q

Lymph2Cx assay in DLBCL
LymphoGen

A

Nano-string gene profiling
Better sensitivity for subclassification for GCB/non GCB

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5
Q

ctDNA DLBCL

A

Better in detecting post Tx minimal disease than imaging. not clinically available

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6
Q

Pts with most benefit from pola in DLBCL

A

Age> 60
IPI 3-5
ABC

Approved for IPI >= 2

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7
Q

CART in 1st line DLBCL

A

R-CHOP lead of 1-2 cycles
High risk pts
ZUMA12 (high IPI, DH or positive interim PET)
ZUMA23 (high risk pts)

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8
Q

Tafasitamab in 1st line DLBCL

A

CD19 Ab
Front-MIND
Tafa-len 1st line trial vs RCHOP
Investigational
Result pending

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9
Q

2nd line CART in DLBCL

A

Axi-cell (CD28) ZUMA7
OS
Liso-cell (4-1BB)- less toxic TRANSFORM

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10
Q

CART trials in DLBCL

A

Axi
ZUMA7- 2nd line
bridging with steroids only
OS advantage
ZUMA1- 3rd line

Liso
TRANSFORM- 2nd line
TRANSCEND- 3rd line

Tisa
BELINDA- 2nd line- negative trial
JULIET- 3rd line

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11
Q

IgHVH4-34 gene phonotype in DLBCL

A

ABC
poor prognosis

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12
Q

Advantage of geriatric assessment in DLBCL

A

Better identifies pts above/below age 80 as fit/unfit/frail

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13
Q

X6 RCHOP vs 8X RCHOP in DLBCL

A

GOYA trial
same effectiveness

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14
Q

GCSF support in RCHOP

A

Primary prophylaxis in age > 65
Or comorbities, prior infections, prior cytopenias

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15
Q

Polatuzumab in 1st line DLBCL

A

6X Pola-RCHP + 2X R
vs RCHOP
76% vs 70% 2 year PFS
no OS
advantage in ABC, IPI >3, Age>60
higher rates of febrile neutropenia and peripheral neuropathy

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16
Q

Tafa+ Len Tx in DLBCL

A

L-MIND
2nd-3rd line
compared to len
60% ORR CR 40%
median PFS 12 months
well tolerated

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17
Q

Tafasitamab

A

CD19 Ab

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18
Q

DA-EPOCH-R OS in PMBCL

A

Nearly 100% long time OS

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19
Q

PMBCL subtype

A

Closer to ABC
MUM1+

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20
Q

HIV associated DLBCL subtypes

A

Mild immunodeficiency - GCB/BL
Severe immunodeficiency - ABC

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21
Q

HIV associated DLBCL Tx

A

DA-EPOCH-R
But with much lower doses
Specifically for cytoxan
CNS porphylaxis
88% ORR

22
Q

Testicular, leg type and PCNSL immunophenotype

A

MYD-88
PDL-1
PIM1
CD79b

23
Q

Testicular lymphoma Tx

A

R-CHOP
+
Orchiectomy and contralateral RT
+
CNS prophylaxis

24
Q

PCNSL workup

A

Testicular US
Eye exam
BMB
Spinal MRI
PET-CT

25
Q

Luncastuximab Tesirine in DLBCL 3rd line

A

CD19 with chemo attached
single arm in advanced lines
25% CR
PFS 5 months
bridginig?

26
Q

Glofitimab in DLBCL 3rd line

A

2:1
CD20:CD3
IV
12 cycles
Phase II
CR 40%
mPFS 5 months
Obinotuzumab lead in

27
Q

Epcoritimab in DLBCL 3rd line

A

1:1
SC
until progression
CR 40%
PFS 5 months

28
Q

Axi-cell 2nd line in DLBCL

A

ZUMA7
bridging with steroids only
pts rapidly progressing were excluded
crossover allowed
CR 65%

29
Q

Tisa-cell 2nd line in DLBCL

A

BELINDA
negative study
bridging therapy allowed
crossover allowed
CR 30%
Long time of production

30
Q

Liso-cell 2nd line in DLBCL

A

TRANSFORM
Salvage allowed
CR 66%
Sorting of CD4 and CD8 in order to give 1:1 ratio
Done in order to reduce toxicity
Less toxic

31
Q

Adriamycin dose adjustments

A

CKD- no need to dose adjust
Liver- reduce to 50% if bili 1-3, 25% if 3-5, don’t adminster if >5

32
Q

Early PTLD definition

A

12-24 months post transplant

33
Q

Late PTLD time of occurrence

A

5-10 post transplant

34
Q

Risk factors for failure of single agent R in mPTLD

A

High IPI
Bulky disease

35
Q

Risk factors for failure of single agent R in mPTLD

A

High IPI
Bulky disease

36
Q

Risk factors for Tx failure in mPTLD

A

Hypoalbuminemia
BM involvement
CNS involvement

37
Q

1st line Tx for PTLD

A

R x4
Escalation to R CHOP
or
R EPOCH if signs of high-risk disease

If PR but with indolent disease- continue weekly R

38
Q

Sequential Tx in PTLD

A

R X4
Followed by CHOP X4

39
Q

PMBCL immunophenotype

A

CD19, CD20, CD22, CD79a positive
Surface immunoglobulin negative
CD30 weak, CD15 negative

40
Q

Management of Deauville 4 (PR) on end of Tx PETCT in PMBCL

A

FU or RT
Deauville 4 may be a sign of inflammation after DA-EPOCH-R and not of disease

41
Q

DLBCL survival by IPI

A

0- 95%
1-2- 80%
>2- 55%

42
Q

Poor genetic risk in DLBCL

A

MYD88
P53
NOTCH1/2

“MPN”

43
Q

Important signaling pathway in ABC DLBCL

A

NFkB

44
Q

RCHOP-Ibrutinib in 1st line DLBCL

A

Effective in young pts (<60)
And in MCD and N1 genetic phenotypes

45
Q

Tx of early stage DLBCL

A

3 R-CHOP + RT
4 R-CHOP

46
Q

Advantage of DA-EPOCH-R vs RCHOP in PMBCL

A

No need for RT
Better PFS
No random comparsion

47
Q

3rd line Tx in DLBCL

A

Epco/Glofi
Pola-BR
Tafa-Len
Loncatuximab
Selinexor

48
Q

Pola-BR vs BR in RR DLBCL

A

OS advantage

49
Q

CAR-T in 2nd line DLBCL

A

Phase II
PFS and OS advantage

50
Q

Bispecific in DLBCL

A

Better ORR and PFS than pola or tafa based regimens

51
Q

Glofitamab-GemOx in RR DLBCL

A

vs R-GemOx
OS advatage

Erez's HEM TEST notes 2024 (35 decks)

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