Heme Flashcards
What are the components of FLIPI-2? PFS?
Beta MASH
Beta-2 microglobulin
Marrow +
Size >6cm
Hgb <12
Age > 60yra
5yr PFS
Low (0) 80%
Int (1-2) 50%
High (3-5) 20%
R-IPI for DLBCL and 5yr OS estimates?
APLES
Age
PS 2+
LDH >nml
2+ Extranodal sites
Stage III-IV
0=95%
2-3=80%
4-5=60%
6=30%
Deauville score?
1) No uptake
2) <+mediastinum
3) mediastinum<uptake<=liver
4) Uptake moderately > liver
5) Uptake markedly > liver or presence of new lesions
What IHC markers for HL?
CD 15 and 30+, 20 and 45 neg.
Classic HL IPS score?
SAM HALL
Stage IV
Age >=45
Male
Hgb <10.5
Albumin
Lymphocytopenia
Leukocytosis
When would you give ISRT for III-IV classic HL?
Initially bulky or residual after all cycles of systemic therapy.
Breast screening for pts tx with RT for lymphoma?
8yrs after RT or age 40 whatever comes 1st.
Workup for Hodgkins Lymphoma?
B symptoms, CBC, CMP, ESR, LDH, HIV, PET, pregnancy test, fertility counseling.
NCCN criteria for unfavorable HL?
bulky >10cm, B symptoms, ESR >50, >3 sites
Favorable HL pathway if PET2 1-3?
Favorable HL pathway if PET2 with DV 4-5.
Unfavorable HL pathway?
Can also do NIvo-AVDx4 with ISRT 30Gy
Describe ISRT in words?
ISRT targets the originally involved lymph nodes, accounting for inaccuracies in pre-chemotherapy imaging and anatomical changes after chemotherapy.
FLIPI-2?
What do you eval in pt with gastric MALT?
HepB/C, H. pylori (IHC if neg breath or stool), look for t(11:18)
Treatment for testicular DLBCL?
MRI brain/LP
Radical orchietomy–>RCHOPx6 +IT MTXx4–>RT to contra testicle 30/15, frog leg, direct ant electron, bolus, tape penis.
What is R-CHOP?
R = Rituximab
C = Cyclophosphamide
H = Doxorubicin Hydrochloride (Hydroxydaunomycin)
O = Vincristine Sulfate (Oncovin)
P = Prednisone
How do you tx PMBCL?
R = Rituximab
E = Etoposide Phosphate
P = Prednisone
O = Vincristine Sulfate (Oncovin)
C = Cyclophosphamide
H = Doxorubicin Hydrochloride (Hydroxydaunorubicin)
DA-R-EPOCH x 6 🡪 D1-3: observe
If D4-5 biopsy and then tx as refractory or give ISRT 30Gy+ boost PET avid to
FLIPI-2? 5yr PFS?
Beta2 Mg >nml
Marrow+
Age>60yrs
Size >6cm
Hbg <12
Low (0): 80%
Int (1-2): 50%
High (3-5): 20%
What infradiaphragmatic sites are together for GHSG staging?
Paraortic and Mesenteric
Follicular Lymphoma grading?Transformation to DLBCL? Percent risk of +BM? Percent presenting at each stage?
GRADING: # centroblasts / cleaved cells per HPF
1: 0-5
2: 6-15
3: >15 A: centrocytes present, B: lack centrocytes
STAGING
I: 10%
II: 20%
III/IV: 70%
15% transform and 50% BM+.
Criteria for MM? What systemic therapy?
Clonal bone marrow plasma cells >10% or bony/extramedullary plasmacytoma and:
CRAB: hypercalemia, renal insufficieny, Anemia, Bone lesions
or Involved:uninvolved serum free light chains >100, >1 focal lesion on MRI studies.
Daratumumab/lenalidomide
TSEBT script?
12Gy in 8 fractions 4 days a week with electrons
Goal to deliver 12Gy to skin surface using extended SSD using acrylic sheet to scatter dose
2 beams gantry pointing above and below pt +/-20 degrees
Treated using stanford technique; 1 fraction over 2 days using 3 body positions per day.
Shadowed areas supplemented (sclap, axilla, pannus, perineum etc).
Tox: Desquamation, hair loss, lymphedema, nail loss, loss of perspiration, secondary cancer, parotitis.
Mycosis Fungoides T staging? Workup?
T1: <10% BSA
T2: >=10% BSA
T3: one or tumors >=1cm
T4: >80% BSA
CBC w diff, CMP, LDH, flow cytometry with Cezary screen, PET if T3.
