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IP Oncology Exam 3 > Lec 3: Lymphoma > Flashcards

Lec 3: Lymphoma Flashcards

1
Q

HODGKIN LYMPHOMA (HL): GENERAL INFO 1.) Incidence?
2.) Age groups?
3.) The 4 subtypes of classical HL?
4.) Risk factors?

A

-Not very common at all… #27 most common cancer
-More frequently diagnosed in the “younger population” age 20-34 with median age of 39
-4 subtypes: Nodular sclerosis, Mixed cellularity, Lymphocyte-rich, Lymphocyte-depleted
-Risk Factors: Age, Family history of lymphoma, Male gender, Past Epstein-Barr virus infection (like mononucleosis)

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2
Q

WHAT IS HODGKIN LYMPHOMA?

A
  • A group of cancers arising from the lymphocytes, that most commonly involves B-lymphocytes.
  • Lymphomas can begin anywhere in the body where lymphoid tissue is found, including lymph nodes, spleen, bone marrow, thymus, digestive tract, and adenoids/tonsils.
  • Most commonly, initial presentation is in the lymph nodes of the upper part of the body (chest, neck, axilla)
  • In early disease, HL travels via the lymphatic system from lymph node to lymph node, and in more advanced disease can invade the
    bloodstream and spread to lungs, liver, bone marrow, etc.
  • Characterized by the presence of Reed Sternberg cells!! –> THE HALLMARK PRESENTATION
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3
Q

HODGKIN LYMPHOMA: INITIAL PRESENTATION

A
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4
Q

WORK-UP OF HODGKIN LYMPHOMA

A
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5
Q

STAGING AND CATEGORIES OF HODGKIN
LYMPHOMA

A
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6
Q

HODGKIN LYMPHOMA: PROGNOSIS

A
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7
Q

HODGKIN LYMPHOMA: Treatment:
1.) Stage IA/IIA favorable

A
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8
Q

HODGKIN LYMPHOMA: Treatment:
2.) Stage I/II unfavorable

A

ABVD x 2 cycles, then restaging PET/CT, followed by:
- 2 additional cycles of ABVD + radiation
- Or 4 cycles AVD (no bleomycin)
- Or changing therapy

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9
Q

HODGKIN LYMPHOMA: Treatment:
2.) Stage III-IV

A
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10
Q

HODGKIN LYMPHOMA: ABVD Treatment? What are the drugs and doses?

A
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11
Q

ABVD COMPONENTS: DOXORUBICIN

A
  • Drug class: anthracycline
  • Important toxicity: cardiotoxicity with total cumulative doses!… Risk of cardiotoxicity increases rapidly with lifetime doses of 400mg/m2 (but can happen at any dose)
  • Risk of secondary malignancies such as AML
    or myelodysplastic syndrome (MDS)
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12
Q

ABVD COMPONENTS: BLEOMYCIN

A
  • Drug class: antitumor antibiotic
  • Important toxicity: Pulmonary fibrosis: Occurs when cumulative total dose is >400
    units… More common in older patients but all
    patients are at risk
  • Idiosyncratic reactions can occur in 1% of
    patients with Hodgkin’s lymphoma
  • Hypotension, fever, chills, confusion
  • Do test dose of 1 unit with first infusion
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13
Q

BLEOMYCIN: PULMONARY TOXICITY (more info)

A
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14
Q

ABVD COMPONENTS: VINBLASTINE

A
  • Drug class: vinca alkaloid/ antimicrotubular agent
  • Toxicity: Neuropathy
  • Can be confused with vincristine with fatal results
  • Never administer intrathecally fatal!!!
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15
Q

ABVD COMPONENTS: DACARBAZINE

A
  • Drug class: alkylating agent
  • Case reports of drug induced hepatic necrosis
  • Toxicity: Bone marrow suppression
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16
Q

ABVD AND FILGRASTIM ?

A
17
Q

Additional agent for Stage 3-4 Hod Lymp: BRENTUXIMAB VEDOTIN

A
  • Drug class: anti-body drug conjugate (Anti-CD 30 antibody conjugated to MMAE (an
    anti-microtubule agent ))
  • Do not use with bleomycin
  • Causes bone marrow suppression and other common chemotherapy-related effects
  • Important toxicity: peripheral neuropathy
  • Contraindicated in patients with neuropathy (DO NOT USE IN PATIENT WITH NEUROPATHY)
18
Q

HODGKIN LYMPHOMA: Supportive Care

A
19
Q

NON-HODGKIN LYMPHOMA:
1.) Incidence?
2.) Age?
3.) What is it?
4.) Risk Factors?

A

1.) Incidence: More common than Hodgkin Lymphoma! #7 most common cancer
.
2.) Age: Frequently diagnosed in age range of 64-74 (median age 67)
.
3.) What is it: Heterogeneous group of lymphoproliferative disorders affects patients from childhood to older adulthood -> Numerous different types of NHL! treated differently, different outcomes, and life expectancies…Better treatments have resulted in a decline in mortality rate over the last 30 years
.
4.) Risk Factors? Use of immunosuppressive drugs, Organ transplant (PTLD- post-transplant lymphoproliferative disorder), Previous radiation or chemotherapy, Agent orange exposure, Infections such as HIV, EBV, Hepatitis C, Hepatitis B, and HTLV-1

20
Q

TYPES OF NON-HODGKIN LYMPHOMA: Survival? Curable?

A
21
Q

NON-HODGKIN LYMPHOMA: Diffuse large B-cell lymphoma -> Initial Presentation

A
  • Rapidly growing/swollen lymph nodes
    -~40% of patients present with B-symptoms -> Fevers, Unexplained weight loss of > 10% body weight over 6 months, Night sweats
22
Q

NCCN GUIDELINES TX: NON-HODGKIN LYMPHOMA: 1st line tx

A

NOTE:
- Nonbulky = < 7.5cm
- Bulky = >7.5cm

23
Q

NON-HODGKIN LYMPHOMA: R-CHOP - Drug and doses?

A
24
Q

R-CHOP COMPONENTS - RITUXIMAB

A
  • Drug class: Anti-CD-20 monoclonal antibody
    .
    TOXICITIES:
  • Infusion reactions: Range from minor to fatal.. all patients should receive premedication
  • Hepatitis B re-activation - patients should be screened for Hep B before administration monitor during and after rituximab and discontinue if reactivation occurs
25
Q

R-CHOP COMPONENTS - CYCLOPHOSPHAMIDE

A

-Drug class: alkylating agent
- Cardiotoxicity possible at high doses
- Moderate emetogenic potential
- Pulmonary toxicity
- Renal toxicity
- Hemorrhagic cystitis, hematuria at high doses

26
Q

R-CHOP COMPONENTS - DOXORUBICIN

A
  • Drug class: anthracycline
  • Important toxicity: cardiotoxicity with total cumulative doses: Risk of cardiotoxicity increases rapidly with lifetime doses of 400mg/m2 (but can happen at any dose)
  • Risk of secondary malignancies such as
    AML or myelodysplastic syndrome (MDS)
27
Q

R-CHOP COMPONENTS - VINCRISTINE

A
  • Drug class: Vinca alkaloid
  • Toxicity: neuropathy
  • When administered intrathecally causes
    progressive paralysis and death
    ——- Dispensed from the pharmacy in a mini bag (NOT syringe) to prevent any confusion with an intrathecal chemotherapy given the same day
  • Maximum dose is 2 mg
28
Q

R-CHOP COMPONENTS - PREDNISONE

A
  • Drug class: Corticosteroid
  • Adverse effects:
    —- Insomnia
    —- Psychiatric disturbances
    —- Hypergylcemia
    —- Weight gain
    —- Cushing syndrome
    —- Edema
29
Q

NON-HODGKIN LYMPHOMA: SUPPORTIVE CARE

A

IP Oncology Exam 3 (5 decks)

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