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Hematology, oncology > Follicular lymphoma > Flashcards

Follicular lymphoma Flashcards

1
Q

Treatment of grade 3 FL or aggressive presentation

A

R-CHOP chemotherapy

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2
Q

what is R-CHOP

A

rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone

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3
Q

Clinical benefit of maintenance rituximab

A

Controversial – improves PFS but no survival benefit.

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4
Q

Management of advanced FL

A

IF asymptomatic –> monitor (can live for many years)

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5
Q

Typical clinical course of indolent lymphomas

A

Respond well to therapy, but most eventually progress (largely incurable)

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6
Q

survival of FL

A

Many have long term survival (20 years)

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7
Q

typical course

A

waxing and waning

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8
Q

characteristic immunophenotype of FL

A

CD20+, CD10+, BCL2+, CD5-, cyclin D1-

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9
Q

lymphoma grade that tends to behave more aggressively

A

Grade 3 and above

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10
Q

Branch point in management

A
  • Grade 1-2 – treated as indolent lymphoma

- Grade 3-4 – treated aggressively with R-CHOP

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11
Q

Scoring system for prognosis

A

FLIPI

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12
Q

When to initiate treatment in advanced stage:

A

1) B-symptoms 2) Compromise of normal organ function due to progressive or bulky disease 3) Pleural effusions or peritoneal ascites 4) Cytopenias due to extensive bone marrow infiltration 7) autoimmune hemolytic anemia 8) splenomegaly 9) involvement of 3 or more sites, each with a diameter of 3 cm or larger

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13
Q

Why are asymptomatic patients with single site of disease commonly treated?

A

There’s good evidence that these people will never relapse

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14
Q

Why watchful waiting is an effective strategy?

A
  • 1) Many can live for long time
  • 2) Some go into spontaneous remission
  • 3) Treatments haven’t shown a survival benefit
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15
Q

First line Treatment options for advanced stage

A
  • R-CHOP
  • BR
  • R2
  • R-CVP
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16
Q

How to select induction therapy

A
  • age, comorbidities (cardiac disease)

- Disease grade

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17
Q

Best option in research in terms of PFS

A

BR

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18
Q

What is CVP regimen?

A

Cyclophosphomide, vincristine, prednisone

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19
Q

BR is

A

Bendamustine, rituxan

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20
Q

Role for maintenance therapy + agent?

A

Used in PR, benefit in CR remains controversial rituximab

21
Q

Management of Relapse

A

No standard second line

22
Q

Pi3K inhibitors approved for FL

A

Idelalisib, duvelisib, Copanlisib

23
Q

Main SE to know with Idelalisib

A

Severe diarrhea and colitis

24
Q

Management of colitis with Idelalisib

A

Steroids

25
Q

What is R^2?

A

Rituximab + lenalidomide

26
Q

Stage III disease means

A

Nodes on both sides of the diaphragm

27
Q

Stage IV disease means

A

noncontiguous extralymphatic involvement

28
Q

Stage I means

A

one node or a group of adjacent nodes

29
Q

Stage II means

A

Two or more nodal groups on the same side of the diaphragm

30
Q

Induction therapy for double hit DLBCL

A

da-EPOCH-R vs. R-hyperCVAD/MA

31
Q

Response assessment for DLBCL

A

PET/CT 6-8 weeks after completion of chemotherapy

32
Q

transformation is referred to as

A

“histologic transformation”

33
Q

Role for RT in FL?

A

Limited to palliative radiation for locally symptomatic disease.

34
Q

Role or transplant in FL?

A
  • reserved for patients with relapsed or refractory FL or for those with histologic transformation
35
Q

Important distinction in grading of FL

A

Grade 3b is more aggressive and referred t

36
Q

Follicular large cell lymphoma is also referred to as

A

Grade 3b disease

37
Q

immunophenotype of FL

A

CD10+
CD19+
CD20+
BCL2

38
Q

characteristic chromosomal abnormality of FL

A

t(14;18) (leads to transcription of excessively high levels of BCL-2, which inhibits cells from undergoing apoptosis)

39
Q

Definition of FL grade 3b

A
  • greater than 15 centroblasts per HPF with solid sheets of centroblasts
40
Q

Clinical characteristics of grade 3b FL

A
  • distinct subset that shares many features with DLBCL
41
Q

Variables included in FLIPI score

A
  • age over 60
  • stage III or IV
  • hbg less than 12
  • LDH greater than the ULN
42
Q

typical presentation

A

DISSEMINATED, not localized

- multistation lymphadenopathy + splenomegaly + bone marrow involvement

43
Q

chromosome abnormality characteristic of FL

A

t(14;18)

44
Q

FL immunophenotype

A

CD10 + CD19 + CD20 + often BCL2

45
Q

indolent biology in FL refers to

A

Grade I-II

46
Q

Can you retreat with rituxan in FL?

A

yes

47
Q

Gene on chromosome 18

A

BCL2

48
Q

Criteria used for starting treatment in FL

A

GELF criteria

49
Q

Management of patients with low grade low tumor burden or ineligible for combination therapy

A

rituximab monotherapy

Hematology, oncology (218 decks)

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