Hematologic Malignancies Flashcards
What is Lymphoma?
- Deals with Lymphatic System and the malignant transformation of lymphocytes [B-Cells]
What are the two main types of Lymphomea?
- Hodgkins [Reed-Sternberg Cells]
- Non-Hodgkinis
What is the pathophysiology of Hodgkins Lymphoma [HL]?
- Reed-Sternburg Cells; B-Cell transcriptions disupted [loss of immunoglobulin & lack of apoptosis]
- Overexpression of kB
What are some of the risk factors for Hodgkins?
- Epstein-Barr: Changes B Cell DNA
- Unable to remove the damages B Cells
What are some of the presentations for Hodgkins?
- Painless, Rubbery, enlarged Lymph Node
- B Symptoms: Fever, Sweaty, Weight Loss
- ICTHING
What is the way that we can diagnosis for Hodgkin?
- Excisional Biopsy [remove lymph]
- CT/PET scan
- Bone Marrow Biopsy
What is Ann Arbor Staging in Hodgkins?
- A = Aysmptomatic
- B = B Symtpoms
- Stage I –> IV: how many radiation fields are needed to treat
What are the classifications for Hodgkins?
- Early Stage Favorable: Stage I & II WITHOUT unfavorable factors
- Early Stage Unfavorable: Stage I & II WITH unfavorable factors
- Advanced Stage: Stage III & IV
What are some of the unfavorable factors that are used in classifications for Hodgkins?
- Large Adenopathy: infections of glands
- Multiple nodes
- B Symptoms
- Extranadol Involved
- ESR
What are the risk factors that go into the Internatinoal Prognostic Scre [IPS] for hodgkins?
- Albumin < 4
- Hemoglobin < 10.5
- Male
- Stage IV
- Age > 45
- WBC > 15,000
- Lymphocytes < 600
What are some of the treatment options for Hodgkins?
- CURE with minimizing toxicities and complications
- Chemo [ABVD or AAVD], Rads, Antuologus Stem Cell Transplant
What is the treatment by stage in Hodgkins?
- Favorable: ABVD + RT
- Unfavorable: ABVD +RT
- Stage III/IV: ABVD +/- RT, AAVD
What are the two main chemotherapy regimens that are used in Hodgkins?
- ABVD
- AAVD
What is in ABVD in Hodgkins?
- Doxorubicin, Bleomycin [Pulmonary Toxicites], Vinblastine, Dacarbazine x28d
What is in AAVD in Hodgkins?
- Doxorubicin, Brentuximab, Vinblastine, Dacarbazine [Myelosuppression & Neruopathy]
What do you do for Relasped Hodgkins?
- High does chemo with AUTOLOGOUS stem cell
- MAINTENANCE Bretuximab vedotin after
Breifly summarize what to do within Hodgkins disease?>
- Early Stage: Radiation, ABVD [2-4 cycles]
- Advanced Stage: ABVD or AAVD [6-8 cycles] {AAVD in younger patients with III or IV}
- Relasped: High dose chemotherapy then stem cell rescue
- Maintenance: Brentuximab
What is the Pathophysiology of Non-Hodgkins?
- Malignant B or T Lymphocytes that proliferate and replace nomral cells in the lymph nodes or bone marrow
- 85% B & 15% T
What are some of the Risk factors for Non-Hodgkins?
- Epstein-Barr Virus: change B cell DNA
- H. Pylori
- Herpes virus 8
How is Non-Hodgkins presented?
- Depends on location: B-cell [lymph node, spllen, bone marrow] & T-cell [skin or lungs]
- Leads to organ destruction [Lymphadenopathy]
What are some of the B Symtpoms?
- Fever
- Sweat
- Weight Loss
What is the way that we are able to dianosis Non-Hodgkins?
- Excisional Biopsy: remove lymph
- CT/PET scan
- Bone Marrow Biopsy
- LUMBER PUNCTURE: not in CNS
What are some of the main differences between Hodgkins and Non-Hodgkins?
- Hodgkins: Single group, Waldeyer ring rarely involved, Extranodal RARE
- Non-Hodgkins: Multiple groups, Waldeyer ring common, Extranodal common
What are some of the B-Cell Lymphomas in Non-Hodgkins?
- Indolent [25-40%]: Long survival & Incurable
- Aggressive [60-75%]: Rapid growth, short survival, CURABLE
- Highly Aggressive: Doubling Time 18hr, Curable [Burkitt’s]
What is the way that we stage Non-Hodgkins?
- Ann Arbor & International Prognostic Index
- IPI: Age > 60, Abnormal LDH, Performace > 2, Ann Arbor III or IV, Extranodal > 2
What are some of the treatments that we can use in Non-Hodgkins?
- Rads, Chemo, Immunotherapy, Autotransplant, CAR-T, BiTE
What is Follicular Lymphoma in Non-Hodgkins?
- 2nd most common: 22% [incurable = slow growth]
- Treat is symptomatic [organ failures, bone marrow failures…]
What are some of the treatments for Follicular Lymphoma in Non-Hodgkins?
- 1st line: Bendamustine + Rituximab, R-CHOP
What is Richter’s Transformation in Non-Hodgkins?
- When Non-Hodgkins becomes Diffuce Large B-Cell Lymphoma [AGGRESIVE]
- Will still have follicular & DLBCL
What is Diffuse Large B-Cell Lymphoma?
- Genetic abnormalities with MYC, BCL2, BCL6 [two = double-hit; three = triple-hit]
What are the multi-agents chemotherapy agents that are used in DLBCL in Non-Hodgkins?
- R-CHOP
- Pola + R + CHP
What is R-CHOP in DLBCL in Non-Hogkins?
- Rituximab [CD20], Cyclophosphamide, Doxorubicin, Vincristine, Prednisone
What is in Pola + R + CHP in DLBCL in Non-Hodgkins?
- Polatuzamab Vedotin, Rituximab, Cyclophosphamide, Doxoubicin, Prednisone
- $400,000!!
What is the treatment for DLBCL in Non-Hodgkins?
- Stage I-II: R-CHOP 3 cycles or 6 cycles
- Stage III-IV: R-CHOP 6 cycles or Pola+R+CHP 6 cycles
What is important to know about Hepatitis B in Non-Hodgkins?
- Reactivation that can cause liver failure and death
- Test HBsAg & HBcAb before Rituximab
- PRETREAT with entecavir [if +]
What is important to know about relapsed DLBCL/Aggressive Non-Hodgkins?
- CURE: salvage chemo [prove chemo works] then autologous stem cell transplant
- Palliative: Bendamustine + Rituximab + Polatuzumab
- BiTE: Epcoritamab or Glofitamab
What are some of the BiTE that are used in Non-Hodgkins?
- Epocoritamab & Glofitamab
- Helps move T-cells closer to B-cells [CD3 to CD19] causing b-cell lysis
What is Burkitts Lymphoma?
- HIGHLY AGGRESSIVE [DLBCL]
- Always MYC translocation
- Starty Sky Apperance
What is the Pathophysiology of Multiple Myeloma?
- Abnormal clonal plasma cells that go into the bone marrow causing MM cells to NOT DIE
- Releases Immunoglobulins [IgG 60%]
What is Presentation of Multiple Myeloma?
- C: hyperCalcemia
- R: Renal dysfunction
- A: Anemia
- B: Bone - one or more lesion
What is the treatment strategies for Multiple Myeloma?
- Transplant?
- NO: 3 drugs
- YES: 3 drugs –> Stem Cell
Breif summary of Multiple Myeloma?
- INCURABLE
- 3 DRUGS BOI
- High dose chemo then stem cell [Induction–>consolidation–>maintenance]
Brief summary of Lymphoma?
- Hodgkins and Non-Hodgkins
- Hodgkins = ABVD
- Non-Hodgkins = R-CHOP
