HEME Flashcards
Treatment for Stage I-IIA NLPHL bulky or I-IIB
Rituximab chemo + ISRT 30-36 Gy
B symptoms
Fever>100.4, night sweats, weight loss> 10% baseline in 6 months
Who needs LP in lymphoma workpu
Primary cns, HIV-associated, primary testicular, bone marrow involvement, paranasal sinus primary, double-hit lymphoma
Treatment of limited stage bulky DLBCL
RCHOP x6 + ISRT 30 Gy
What is the NHL chemo regimen
R-CHOP, ritux, cyclopho, adria, vincrist, prednisolone
Treatment of limited stage non-bulky DLBCL
RCHOP x3 –> PET CT D1-3: ISRT 30 Gy, D4-5: Rchop x 3 –> PET CT (D1-3: ESRT 30 Gy, D4-5: biopsy negative: ISRT, or just do RCHOP x4 if all disease resected on excisional biopsy.
Ann arbor staging
Stage I: single lymphatic site or single extra lymphatic site, STAGE II, >=2 LN regions on the same side of diaphragm, Stage III, both sides of diaphragm, Stage IV diffuse disseminated involvement of 1 or more extranodal organs, B: b symptoms (HL only), E: extralymphatic tissue
Treatment for Favorable Stage I-IIA HL
ABVDx2 –> PET CT D1-3: ISRT 20 Gy, D4: ABVD x 2 + ISRT 30 Gy, D5: biopsy (negative: ABVD x2 + ISRT 30 Gy positive: refractory pathway)
What is the chemo regimen for HL
ABVD, adria, bleo, vincblastine, dacarb
How to treat h. pylori positive translocation positive malt lymphoma
triple therapy and ISRT 24Gy/1.5Gy
Hodgkin lymphoma type of cells
reedd sternberg
IPI
Age>60, ECOG>1, Elevated LDH, >1 extranodal site, Stage III-IV
Heart mean with lymphoma RT
<5 Gy (<15 Gy)
Lab workup for suspected lymphom
CBC, CMP, LDH/ESR, HIV, Hepatitis panel, Beta 2,
Submandibular gland mean
<11 Gy
NLPHL markers
CD15-, CD30-, CD20+, CD45+
Who needs BM biopsy in lymphoma workup
FL and DLBCL, HL only if unexplained cytopenias and negative PET CT
Lung V5
<55%
What markers are indicative of Hodgkin Lymphoma
CD15+, CD 30+, CD 20-ve
Treatment for Unfavorable Stage I-IIA HL
ABVDx2 –> PET CT D1-3: ABVD x2 + ISRT 30 Gy, D4: eBEACOPP x 2 + ISRT 30 Gy), D5: biopsy (negative: ABVD x2 + ISRT 30 Gy positive: refractory pathway)
Flipi-2
Age>60, Hgb<12 g/dl, LN>=6cm, elevated beta 2microglobulin, BM involvement
How to treat h. pylori negative gastric malt
ISRT 24 Gy/2Gy, Rituximab
What is the translocation that confers antibiotic resistance in gastric malt
t(11:18)
How to treat Classical HL for pediatrics, Stage IA-IIA nonbulky
AV-PC x3, ISRT 21 Gy if partial response
Treatment for Stage I-II follicular lymphoma
ISRT 24 Gy/2Gy
Lung mean
<10 Gy
Lung V20
<30%
Treatment for PMBCL
daR-Epoch x 6 –> PET CT D1-3: NFT, D4-5: biopsy positive: ISRT 30 Gy + boost to residual disease 40-45 Gy
What are HL unfavorable risk factors per GHSG
A: ESR>50, B: ESR>30, MMR>0.33, >2 nodal sites, any extranodal lesion
How to treat Classical HL for pediatrics, Stage IB-IIB or bulky stage IIIA-IVA
ABVE-PC x 4, RER and CR observe, SER or PR: ISRT 21 Gy
Clonality needed for multiple myeloma
bm clonal plasma cells>10% or plasmacytoma and one of CRAB-SLM
What are the HL risk groups
Early stage (StageI and Stage II non-bulky) Advanced stage (Stage II bulky and Stage III-IV)
How to treat solitary plasmacytoma
RT to 40-50 Gy
How to treat h. pylori positive translocation negative malt lymphoma
triple abx, omeprazole, amox, clarith, repeat endoscopy, if positive, abx again, if negative, q3mo endoscopy until 18 mo then ISRT 24 in 12 if progressive or symptomatic
Treatment for Stage I-IIA NLPHL (nonbulky
ISRT 30-36 Gy
FLIPI-1
Age>60, Hgb<12g/dl, >=5 LN stations, Elevated LDH, Stage III-IV
Thyroid Lymphoma RT constraint
V25<63.5%
What is the RT dose for peds HL
21 Gy
What defines bulky disease for Lymphoma
HL: 10 cm, DLBCL 6-10 cm, FL 7 cm
Breast mean with lymphoma RT
<4 Gy (<15 Gy)
What is the workup for Testicular Lymphoma?
AFP/b-HCG, Testicular US and exam, LP
What is the management for primary testicular Lymphoma?
Radical inguinal orchiectomy then RCHOP x6 and IT methotrexate and contralateral testis RT to 30 Gy
What is included in the primary CNS workup?
LP, slit lamp exam, testicular US and exam if older men
What is the management for PCNSL?
R-MVP (ritux, methotrex, procarb, vincris) then consolidation Radiation
What is the dose for consolidation RT for PCNSL?
CR: WBRT 23.4 Gy/1.8Gy, PR: WBRT 30.6Gy/1.8Gy + residual disease IMRT boost to 45 Gy/1.8Gy
What is the anterior border of the WBRT field for PCNSL?
A posterior globe 5mm behind lens
What is the inferior border of the WBRT field for PCNSL?
C2/C3
Who should you avoid WBRT for PCNSL?
Age > 60
What is the treatment for NKTCell lymphoma?
CCRT 50.4 Gy/1.8Gy + DeVIC (dex, etop, ifos, carbo)
What are the standard treatment volumes for NKTCell Lymphoma?
Bilateral nasal cavity, bilateral anterior ethmoid sinus, bilateral hard palate, ipsi maxillary sinus
two treatment options for mantle cell lymphoma
36 Gy alone or chemo then 24 for CR, 36 for PR
chemo for stage I and II mantle cell lymphoma
Ritux + bendamustine + acalabrutinib
BrECADD
Brentuximab vedotin, Etoposide, Cyclophosphamide, adriamycin, dacarbazine, dexamethasone
