Lymphoma

Question 1

CD20/21+, CD5- CD10+, BCL-6+, BCL2+, t(14;18)

Answer 1

follicular lymphoma

Question 2

cyclin D1 translocation and disease

Answer 2

t(11q14), mantle cell lymphoma (MCL)

Question 3

when to treat follicular lymphoma

Answer 3

GELF positive: 
B symptoms 
Splenomegaly
Pleural effusion or ascites
3 node sites >3 cm
one node >7 cm 
cytopenias leukocytes or plts <100
leukemia

Question 4

Single agent rituxan in follicular lymphoma

Answer 4

Data shows single agent robust activity
74% RR 4 weeks of weekly ritux
RESORT trial maintenance was not helpful for OS, prefer retreat when recurrs

Question 5

PRIMA trial

Answer 5

relapse risk determined by FLIPI
given R+ chemo of some kind then maintenance ritux for 2 years 375 mg/m2 every 8 weeks or not
PFS 75 vs 58 but no OS

Question 6

stage I or stage II low grade treatment

Answer 6

confirm stage with PET and BMB

Local radiation preferred with high long term cure DFS and about 40% cure rates

Question 7

B cell lymphoma with >15 centroblasts/hpf and solid sheets of centroblasts and treatment

Answer 7

grade 3B follicular lymphoma is treated with R-CHOP, >65 and poor PS BR

Question 8

Gastric MALT t(11;18) translocation/FISH

Answer 8

predicts a lack of benefit to H. pylori therapy <5%, treat for H pylori and do radiation or rituximab if contraindicated

Question 9

Marginal Zone lymphoma

Answer 9

Marginal zone is marginal

Splenic marginal zone is associated with Hep C and treatment of hep c can induce remission.

Immunophenotype tend to be “bland” CD20/22+ but

CD5-, CD10-, CD25-, CyclinD-, CD 103-

CD23+/-

Question 10

Mantle cell lymphoma maintenance therapy

Answer 10

Yes after aggressive therapies

Elderly or not transplant eligible after R-CHOP but not BR

3 years showed improved OS

Question 11

first line therapy for mantle cell lymphoma

Answer 11

agressive vs non-aggressive

R-CHOP/R-HyperCVAD

Question 12

aggressive features for mantle cell lymphoma

Answer 12

ki67>30%

blastoid variant

Question 13

features for increased risk of CNS involvement in DLBCL

Answer 13

4-6 risk factors CNS IPI 
age >60
LDH elevated
PS>1
Stage III or IV
Extranodal involvement >1 site

Independent factors that support auto use 
Testicular
high grade double hit 
leg primary
IE of the breast 
kidney or adrenal gland

Question 14

cHL immunophenotype

Answer 14

CD 30+, CD15+/-, CD2-+/-, PAX5+ MUM1+

Question 15

CD 30+, CD15+/-, CD2-+/-, PAX5+ MUM1+

Answer 15

classical HL

Question 16

HL risk stratification for various stages of disease

Answer 16

I/II- NCCN
- favorable: no bulky disease >10 cm LN or low mediastinum mass ratio, ESR<50, <3 sites of disease, no B sx
- unfavorable: bulky, ESR>50, >3 sites of disease, B symptoms
III/IV- advanced and uses IPS score
- low risk 1
- int 2-3
- high >4
- points for albumin <4, hgb <10.5, male, age >45, stage IV, WBC >15k, lymphocytopenia ALC <600.

Question 17

brentuximab-vedotin MOA and SE

Answer 17

CD30 monoclonal antibody-drug conjugate with MMAE (microtubule agent)

Neuropathy 
Infusion reactions 
febrile neutropenia- needs G-CSF with AVD
TLS 
Hepatotoxicity 
PML 
pneumonitis 
SJS 
pancreatitis 
hyperglycemia

Question 18

ABVD

Answer 18

Adriamycin- anthracycline
Bleomycin- antineoplastic antibiotic
Vinblastine- microtubule
Dacarbazine- alkylating

Question 19

BEACOPP

Answer 19

Bleomycin
etoposide 
adriamycin
cyclophosphamide
vincristine
procarbazine- alkylating 
prednisone 

g-csf

BEACOPP is associated with higher response rates up to 95% and better rates of PFS than those seen with ABVD, but no improvement in OS. Severe hematologic toxicity, infections, and occurrence of myelodysplastic syndrome and acute myeloid leukemia