Kebbekus- Lymphoma Cases

Question 1

Describe the staging levels of lymphoma.

Answer 1

1- single LN/organ
2->2 LN on same side of diaphragm
3->2 LN above and below diaphragm
4- widespread disease, multiple organs w/ or without LN involvement

Question 2

What are lymph tissues?

Answer 2

Waldeyers ring (tonsils and adenoids)
Spleen

Question 3

What is the treatment for localized (I/II) stage hodgkins?

Answer 3

ABVD x 2

Field radiation

Question 4

What is the treatment for III/IV disease?

Answer 4

ABVD x2
ABVD x2
Intense chemotherapy BEACOPP
Autologous transplant

Question 5

What are the possible late effects of therapy?

Answer 5

Second malignancy
Heart disease
Lung disease
Impaired fertility

Question 6

What second malignancies would you be worried about after therapy for HD?

Answer 6

Solid tumors–lung cancer* and breat cancer

Secondary leukemia

Question 7

Heart disease is an effect of tx for HD because….

Answer 7

it’s associated w/ radtation to mediastinum

Question 8

What effect of therapy is associated w/ bleomycin containing regimens that are combined w/ chest radiation?

Answer 8

Lung disease

Question 9

What immunochemistry is associated w/ DLBCL?

Answer 9

Diffuse large b cell lymphoma

CD5-, CD19, CD20, CD23

Question 10

DLBCL is most common in ….

Answer 10

adults

Prototype for an AGGRESSIVE lymphoma

Question 11

DLBCL is often treated w/

Answer 11

CHOP
cyclophosphamide
oncovin= vincristine
prednisone
doxorubicin

Question 12

What do we add to CHOP now that has made a big difference?

Answer 12

Rituximab

Question 13

How long is CHOP given?

Answer 13

18 weeks

Question 14

What is the most common INDOLENT NHL?

Answer 14

Follicular lymphoma

Question 15

What percent of Follicular lymphoma cases are at an advanced stage at presentation?

Answer 15

80%

Often asymptomatic

Question 16

What traaslocation is associated w/ follicular lymphoma?

Answer 16

t(14;18) (q32,a21)

*BCL-2 is translocated to chromosome 14, comes under control of IgH enhancer which leads to overexpression of Bcl-2

BCL-2 chromosome 18q21 inhibits apoptosis

IgH chromosome 14q32

Question 17

What CD marker is associated w/ follicular lymphoma?

Answer 17

CD20

Question 18

What is the cure rate for follicular lymphoma? Survival?

Answer 18

0%

survival 10-12 years

Question 19

What are the indolent B cell lymphomas?

Answer 19

Follicular- most common
CLL/SLL
Marginal Zone
MALT
LPL or waldenstorm

Question 20

What are aggressive BCLs?

Answer 20

DLBCL

Mantle cell** could also be put in indolent column

Question 21

What is a HIGHLY aggressive BCL?

Answer 21

Burkitt

Younger pt
Start chemo right away
associated w/ EBV

Question 22

What translocation is associated w/ mantle cell lymphoma? Associated w/ what cyclin?

Answer 22

t(11,14)
positive for cyclin D1
atypical lymphocytes

Heavy chain on 14 and cyclin D1 translocation

Question 23

Mantle cell lymphoma is positive for what CD?

Answer 23

CD20

CD5

Question 24

How do you treat pts w/ advanced mantle cell?

Answer 24

Induced w/ RCHOP

autologous stem cell transplant

Question 25

What would flow cytometry show for CLL?

Answer 25

Kappa or lambda light chain but NOT both

CD 5, 19, 20, 23

Question 26

Who should be treated for CLL?

Answer 26

For advanced disease if:
BM failure
massive splenogmegaly
massive lymphadenopathy
progressive lymphocytosis over 2 motnhs
AIHA and thromobocytopenia
B symtpoms

Question 27

What CDs are characteristic of MALT lymhoma?

Answer 27

CDD20

Question 28

MALT is frequently associated w/ what bacteria?

Answer 28

H. pylori

Question 29

How do you treat MALT?

Answer 29

2-3 rounds of earadication, if no clearing 203 courses XRT and chemo

Question 30

Post transplant lymphoproliferative disorder is associated w/ what drugs?

Answer 30

Calcineurin inhbitors

Tacrolimus
Cyclosporine

Question 31

What does EBV induced polyclonal expansionof B cells occur?

Answer 31

Suppresson of T cells leads to loss of suppression of B cell prolif.