Exam 3 - Lymphoma Flashcards
List risk factors for lymphomas? (8)
male gender, older age (younger as well in HL), immunosuppression, infections, environmental exposures, radiation exposure, Epstein-Barr virus, HIV infection
Describe the epidemiology of non-Hodgkin’s lymphoma (NHL)?
occurs more frequently in European descent, B-cells most common
List signs/symptoms of diffuse large B-cell lymphomas (DLBCL)?
B-symptoms (fever, night sweats, significant weight loss as 10% in 6 months), nodal masses, elevated lactate dehydrogenase, bone marrow involvement, AMS
Which mutation is most important in diagnosing NHL?
CD20
What is preferred treatment for NHL? (2)
R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), Pola-R-CHP (polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, prednisone)
What are chemotherapy considerations for CHOP and ABVD therapies? (2)
high emetic risk (give anti-emetic regimen prior) and consider G-CSFs in high risk patients (febrile neutropenia prevention)
What are AEs of CHOP therapy?
infections, fatigue, anemia, alopecia
What is the maximum lifetime anthracycline dose?
450-500 mg/m^2
What are AEs of vincristine? (2)
peripheral neuropathy (max 2 mg dose), constipation
What is an AE of cyclophosphamide?
hemorrhagic cystitis
What is the MoA of rituximab?
anti-CD20 moAb
What are AEs of rituximab? (4)
infusion-related reactions, hepB reactivation, hypogammaglobulinemia (GI perforations), PML
Explain what antibodies are present in acute/chronic HBV infection?
positive HBsAg, positive anti-HBc, positive/negative anti-HBc, negative antiHBs
What is another treatment for NHL?
DA-R-EPOCH (dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin)
When is a DA-R-EPOCH regimen the treatment of choice? What MUST be given following it?
double- or triple-hit B-cell lymphomas; G-CSF
What is the MoA of polatuzumab vedotin (Polivy)?
anti-CD79B conjugated to microtubule disruptor
What are AEs of polatuzumab vedotin (Polivy)? (5)
myal/arthralgia, constipation, peripheral neuropathy, infusion-related reactions, anemias
List relapse/refractory treatments for NHL? (4)
R-ICE (rituximab, ifosamide, carboplatin, etoposide) and GDP (gemcitabine, dexamethasone, carboplatin), autologous stem cell transplant, CAR-T, bispecific moAbs
What is fixed-duration treatment for normal TP53* CLL/SLL?
venetoclax + obinutuzumab
What is indefinite treatment for normal TP53* CLL/SLL?
acalabrutinib +/- obinutuzumab or zanubrutinib or ibrutinib
What is indefinite treatment for mutated TP53* CLL/SLL?
acalabrutinib +/- obinutuzumab or zanubrutinib or ibrutinib
What is fixed duration treatment for mutated TP53* CLL/SLL?
venetoclax + obinutuzumab
What is the MoA of obinutizimab (Grazyva)?
anti-CD20 moAb (2nd gen)
What are AEs of obinutuzumab (Gazyva)? (3)
infusion-related reactions, hepB reactivation, increased viral infection risk
What is the MoA of Bruton tyrosine kinase inhibitors?
block B-cell receptor signaling cascade and prevent proliferation and survival of all B-cells
What is the first generation BTKi? Second? (2)
ibrutinib (Imbruvica); acalbrutinib (Calquence), zanubrutinib (Brukinsa)
What are AEs more associated with the first generation BTKi (ibrutinib)?
atrial fibrillation, bleeding events, diarrhea, HTN
List signs/symptoms of Hodgkin’s lymphomas (HL)?
B-symptoms (fever, night sweats, weight loss), lymphadenopathy, generalized malaise
What is treatment for Stage I/II HL?
ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)
What is treatment for Stage III/IV HL? (3)
ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), BV+AVD (brentuximab vedotin with AVD), escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone)
What is an AE of bleomycin?
pulmonary toxicity
What is an AE of dacarbazine?
cytopenias
What is the MoA of brentuximab vedotin (Adcetris)?
anti-CD30 conjugated to microtubule disruptor
What are AEs of brentuximab vedotin (Adcetris)? (5)
pulmonary toxicity, constipation, peripheral neuropathy, infusion-related reactions, anemias
List relapse/refractory treatments for HL? (3)
R-ICE (rituximab, ifosamide, carboplatin, etoposide) and GVD (gemcitabine, vinorelbine, liposomal doxorubicin), autologous stem cell transplant, immunotherapy (nivolumab, pembrolizumab)
