Lymphoma Flashcards
What is a major difference between Hodgkin’s Lymphoma and Non-Hodgkin’s Lymphoma?
Hodgkin’s: minority, binomial ages (younger and old!)
Non-Hodgkin’s: majority, occurs as B/T/NK cell
- Graded based on disease progression + aggression
What are all the risk factors for lymphoma?
Male
Old age
Immunosuppression
Infections
Environmental exposures
Radiation
Epstein-Barr
HIV
[my old ignorant in-law expect rich eloquent housewives]
What is the most common type of Non-Hodgkin’s lymphoma?
Diffuse Large B-cell Lymphoma (B-cell lymphoma is most common)
How is Non-Hodgkin’s lymphoma classified?
Classified by step in cell maturation process where mutation occurs
(“Cell of origin”)
What is the clinical presentation of Diffuse Large B-Cell Lymphoma?
B-symptoms (FEVER, NIGHT SWEATS, WEIGHT LOSS)
Nodal masses (nodes full of immature cells)
Increased Lactate Dehydrogenase (cell turnover marker, since lymph nodes swell and cause cell lysis)
Bone marrow involvement
Altered mental status
Increased SCr, uric acid, liver enzymes, electrolytes (tumor lysis syndrome)
What are the specific risk factors for Non-Hodgkin’s lymphoma?
Immunosuppression
Environmental factors
Radiation exposure
What is required for the diagnosis of Non-Hodgkin’s lymphoma?
LYMPH NODE BIOPSY - confirm various mutations including CD20
Imaging- PET, CT scans
Assess cell of origin (Germinal (favorable) or Activated?)
For prognosis assessment of Non-Hodgkin’s lymphoma, what tool is used? What factors are involved with assessment?
International Prognostic Index (IPI)
Age (older = worse)
Lactate dehydrogenase (>3 is bad)
Extranodality
Performance status
Overall risk grouping
What are the TWO preferred treatment regimens of Non-Hodgkin’s?
R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone)
Pola-R-CHP (Polatuzumab vedotin, Rituximab, Cyclophosphamide, Doxorubicin, Prednisone)
H = Doxarubicin, O = Vincristine, don’t question it
What is an alternative to R-CHOP/Pola-R-CHP for Non-Hodgkin’s treatment?
DA-R-EPOCH (Dose Adjusted Rituximab, Etoposide, Prednisone, Vincristine, Cyclophosphamide, Doxorubicin)
If a Non-Hodgkin’s patient has poor LV ejection fraction, what are preferred first line treatments?
DA-R-EPOCH (contains cardiotoxic drug Doxorubicin but slower infusion is ok!)
Alts:
- R-CDOP (rituximab, cyclophosphamide, liposomal doxorubicin, prednisone)
- R-GCVP (rituximab, gemcitabine, cyclophosphamide, vincristine, prednisone)
- R-CEOP (rituximab, cyclophosphamide, etoposide, vincristine, prednisone)
If a Non-Hodgkin’s patient is frail or >80 yo, what is the preferred first line treatment?
R-mini CHOP
(Lower intensity R-CHOP)
If a Non-Hodgkin’s patient has concurrent CNS disease, what are preferred first line treatments?
Lumbar punctures with chemo
High dose methotrexate
What are two considerations of using CHOP in Non-Hodgkin’s?
HIGH emetic risk! (PRN antiemetics)
Moderate febrile neutropenia risk (consider G-CSF after chemo)
What are some AEs with CHOP therapy in Non-Hodgkin’s?
Infections, fatigue anemia, thrombocytopenia, alopecia
Doxorubicin: cardiotoxicity (anthracycline, limit max lifetime dose <500)
Vincristine: peripheral neuropathy
Cyclophosphamide: hemorrhagic cystitis
Prednisone: insomnia, GI upset, high BG (steroid effects)
After CHOP, how long should prednisone be continued (including day of chemo)?
5 days prednisone
How many cycles of CHOP are usually used in Non-Hodgkin’s? What is the maximum vincristine that can be given in any one cycle?
6 cycles of 21 days
Vincristine = 2 mg maximum
For CD20-positive Non-Hodgkin’s patients, what drug is used? When do we give it timing-wise?
Rituxumab (basically everyone gets)
Administered before CHOP