Kebbekus IHO Week 4

Question 1

Typical presentation of Hodgkins Lymphoma

Answer 1

enlarging, rubbery, but not tender lymphadenopathy; typically in the neck or chest

Question 2

Symptoms that can accompany Hodgkins Lymphoma

Answer 2

fatigue, fever, weight loss, night sweats, pain with EtOH, sx of cytopenias, hepatosplenomegaly, pruritis

Question 3

malignant cell is Reed-Sternberg cell, now recognized as a B-cell some are CD20+, bulk of the tumor is reactive tissue, spreads contiguously from node to node

Answer 3

Hodgkin Lymphoma

Question 4

CD30+, nodular sclerosis (grades I and II), lymphocyte-rich classical, mixed cellularity, lymphocyte depleted

Answer 4

Classical HL (WHO)

Question 5

CD20+

Answer 5

Nodular Lymphocyte Predominant (WHO)

Question 6

Staging Lymphomas A

Answer 6

no systemic symptoms

Question 7

Staging Lymphomas B

Answer 7

fever, night sweats, weight loss

Question 8

Staging Lymphomas E

Answer 8

extralymphatic site

Question 9

Staging Lymphomas S

Answer 9

splenic disease

Question 10

Localized favorable risk disease treatment

Answer 10

ABVD x 2

Question 11

Stage 3 and 4 Disease

Answer 11

ABVD x 2 (restage), ABVDx4, +/- XRT, ABVDx2 (restage-refractory) intense chemotherapy BEACOPP, autologous transplant

Question 12

Late Effects of Therapy-Second Malignancy

Answer 12

solid tumors (lung and breast cancer) and secondary leukemia, heart disease, lung disease, impaired fertility

Question 13

IPI Scoring System Prognostic Factor

Answer 13

age over 60, stage 3 and 4, ECOG PS (eastern cooperative oncology group performance status) 3 or 4 more than 1/2 day resting, elevated LDH, 2 or more extranodal sites

Question 14

Average age of onset of Diffuse Large B-cell Lymphoma

Answer 14

67 (75% over age 55)

Question 15

what is the prototype aggressive NHL of adults

Answer 15

Diffuse Large B-cell Lymphoma

Question 16

most common indolent NHL, that accounts for 22% in North America and is rare in Asia

Answer 16

Follicular Lymphoma

Question 17

This is typically advanced at presentation and is often aymptomatic and NOT curable

Answer 17

Follicular Lymphoma

Question 18

Cytogenetics of Follicular Lymphoma

Answer 18

t(14;18)(q32;q21)
BCL-2 chromosome 18q21 inhibits apoptosis
IgH chromosome 14q32

Question 19

Treatment of Indolent NHL

Answer 19

Only when forced to: pushy nodes (hydrophephrosis, jaundice, dysphagia/stridor), cytopenias (bone marrow failure), B symptoms or fatigue

Question 20

Risk of treating NHL?

Answer 20

transformation to aggressive lymphoma

Question 21

frequently H.pylori associated, tx with 2-3 rounds of eradication, time between EGDs, if no clearing of MALT after 2-3 courses then radiation and/or chemo and/or rituximab, ds outside the stomach or diffuse large cell transformation–chemotherapy

Answer 21

MALT Lymphoma

Question 22

NHL Indolent (follicular, MALT, marginal zone, SLL) survival, curability and to tx or no?

Answer 22

years, generally not curable, defer tx until sx

Question 23

NHL Aggressive (DLBC, Mantle Cell) survival, curability and to tx or no?

Answer 23

months, curable in some, treat

Question 24

NHL Very Aggressive (lymphoblastic Burkett, Aids related) survival, curability and to tx or no?

Answer 24

weeks, curable in some, tx

Question 25

Hodgkin Lymphoma all types survival, curability and to tx or no?

Answer 25

variable (months to years), curable in most, treat

Question 26

What is the prototype of T cell lymphomas?

Answer 26

Mycosis fungoides

Question 27

What are the general principles of T cell lymphomas?

Answer 27

not curable, frequentl relapse but systemic involvement is uncommon, treatment is UV light radiation, topical or systemic

Question 28

First line of treatment for Systemic T cell lymphoma?

Answer 28

CHOP (NOT rituximab); if CD30+ then brentuximab vedotin as targeted therapy

Question 29

What to use to tx Hodgkins?

Answer 29

ABVD: adriamycin, bleomycin, vinblastine and dacarbasine (not lung toxicity of bleomycin)

Question 30

Chlamydia psittaci

Answer 30

Ocular adnexa; MALT