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Hematology and Oncology > EXAM #3: LYMPHOMA II > Flashcards

EXAM #3: LYMPHOMA II Flashcards

1
Q

What is the age distribution of HL?

A

Bimodal distribution:

1) 2nd and 3rd decades
2) Older than 50

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2
Q

Describe the presentation of HL.

A

B Symptoms:

  • Fever
  • Chills
  • Night sweats
  • Pruritus
  • Weight loss
  • Lymphadenopathy, mostly above the diaphragm
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3
Q

How is the lymphadenopathy in HL described?

A

Contiguous and nontender

vs. sporadic in NHL

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4
Q

How is HL diagnosed?

A

1) Lymph node biopsy
2) CBC and acute phase reactants
3) PET scan
4) Bone marrow biopsy

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5
Q

How is HL staged?

A 
I= 1x nodal region 
II= 2x nodal regions on one side of the diaphragm 
III= Both sides of the diaphragm 
IV= more than one extranodal site
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6
Q

What does A mean in HL?

A

asymptomatic

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7
Q

What does B mean in HL?

A

B symptoms

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8
Q

What does X mean in HL?

A

“Bulky Disease”

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9
Q

What cell is there a neoplastic proliferation of in HL?

A

Reed-Sternberg

ALWAYS a B-cell cancer

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10
Q

What are the characteristics of RS cells?

A

1) Mulilobed nuclei
2) Owl eye
3) CD15 and CD30 positive

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11
Q

What are the subtypes of HL?

A

Nodular sclerosis
Lymphocyte rich
Mixed cellularity
Lymphocyte-depleted

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12
Q

What is the most common subtype of HL?

A

Nodular sclerosis

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13
Q

What subtype of HL has the best prognosis?

A

Lymphocyte-rich

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14
Q

What is the subtype of HL with the worst prognosis?

A

Lymphocyte-depleted

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15
Q

How is HL treated?

A

1) Chemotherapy (I-IIA)

2) Radiation (IIB- IV)

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16
Q

What is the standard chemotherapy regimen for HL?

A

ABVD regimen:

  • Adriamycin
  • Bleomycin
  • Vinblastine
  • Dacarbazine
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17
Q

What is more common, HL or NHL?

A

NHL

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18
Q

What infection is associated with Burkitt’s Lymphoma and Nasopharygeal Lymphoma?

A

EBV

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19
Q

What infection is associated with Adult T-cell Lymphoma/Leukemia?

A

HTLV-1

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20
Q

What infection is associated with Gastric MALT Lymhoma?

A

H. pylori

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21
Q

What is the most common etiologic factor in NHL?

A

Prior chemotherapy and radiation

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22
Q

How is NHL diagnosed?

A

Lymph node biopsy

Bone marrow biopsy

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23
Q

How does the presentation of HL and NHL differ?

A

B-symptoms are only seen in v. aggressive NHL

24
Q

What is the additional procedure that may be required for the diagnosis of NHL?

A

Lumbar puncture

25
Q

What is the translocation seen in Follicular Lymphoma?

A

t(14:18), bcl-2

26
Q

What is the translocation seen in SLL?

A

t(14:19), bcl-3

27
Q

What is the translocation seen in Mantle Cell Lymphoma?

A

t(11:14), Cyclin D1

28
Q

What is the translocation seen in Burkitt’s Lymphoma?

A

t(8:14), c-myc

29
Q

What is the translocation seen in Diffuse Large B-Cell Lymphoma (DLCL)?

A

t(3:14), bcl-6

30
Q

What is the most common type of NHL?

A

Diffuse Large B-Cell Lymphoma

31
Q

What is the hallmark indolent or low grade NHL?

A

Follicular Lymhoma

32
Q

What is the hallmark aggressive/ intermediate grade NHL?

A

Diffuse Large B-cell Lymphoma

33
Q

What are the hallmark very aggressive/ high grade NHLs?

A
  • Burkitt’s Lymphoma
  • Lymphoblastic Lymphoma
  • T-cell
34
Q

What is the presentation of DLCL?

A
  • B-symptoms
  • Enlarging mass in nodal or extranodal site
  • More common in elderly
35
Q

What is the most significant prognostic factor in DLCL?

A

Poor performance status (2-4)

36
Q

What is the standard of are for DLCL?

A

Chemotherapy: CHOP + Rituximab

  • Cyclophosphamide
  • Adriamycin
  • Vincristine
  • Prednisone
37
Q

What is Rituximab?

A

Anti-CD20 monoclonal antibody

38
Q

What is the typical presentation of Follicular Lymphoma?

A
  • Enlarging lymph nodes over months to years
  • No B-symptoms
  • Middle/late adulthood
39
Q

What stage are most Follicular Lymphomas when they present?

A

Late i.e. III or IV

40
Q

What is the prognosis for Follicular Lymhpoma?

A

Poor –slow growing makes it v. difficult to treat with chemotherapy and are NOT curable

41
Q

What is the Richter’s Transformation?

A

Transformation of a low grade lymphoma to a higher grade

42
Q

What is the difference between the goals of therapy for stage I and II Follicular Lymphoma vs. stage III and IV?

A

I and II= cure

III and IV= palliation

43
Q

What patient populations are the very aggressive NHLs seen in?

A

Pediatric patients and young adults

44
Q

For patients that have a curative NHL and relapse, what is the prognosis? What is the treatment?

A
  • This is a v. BAD prognostically; this will likely kill the person
  • Treatment involves v. high dose therapy followed by stem cell transplant to buy time
45
Q

What is MALT lymphoma?

A

Marginal zone lymphoma in mucosal sites that is associated with H. pylori infection

Note that it is the chronic inflammatory state i.e. H. pylori infection that “makes” the marginal zone that then undergoes neoplastic proliferation*

46
Q

What is the treatment for MALToma?

A

Treatment of H. pylori

47
Q

What are the common HIV associated Lymphomas?

A

DLCL
Burkitt’s
CNS

48
Q

What viruses are associated with HIV-associated Lymphoma?

A

1) HHV-8

2) EBV

49
Q

What is the most common leukemia?

A

CLL i.e. Chronic Lymphocytic Leukemia

50
Q

What is CLL?

A

Neoplastic proliferation of naive B-cells that express CD5 and CD20

51
Q

What is the typical presentation of CLL?

A

Usually asymptomatic but may have infectious symptoms

52
Q

What are the signs of CLL on exam?

A

1) Lymphadenopathy

2) Splenomegaly

53
Q

What labs are typical of CLL?

A

High WBC count with low IgG, IgA, and IgM in later stages

54
Q

What type of cell is associated with CLL on PBS?

A

Smudge cells

55
Q

Outline the staging of CLL.

A 
0= lymphocytosis 
1= lymphadenopathy
2= splenomegaly 
3= Anemia
4= Thrombocytopenia
56
Q

What is the prognosis for CLL?

A

Not curable; treat with chemotherapy when symptomatic

Hematology and Oncology (38 decks)

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