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703 > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

What are risk factors for lymphoma?

A
  • Male gender
  • Older age
  • Immunosuppression
  • Infections
  • Environmental exposures
  • Radiation exposure
  • Epstein-Barr Virus
  • HIV infection
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2
Q

What are B-symptoms?

A
  • Fever
  • Night sweats
  • Significant weight loss
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3
Q

What are symptoms of DLBCL?

A
  • B-symptoms
  • Nodal mass
  • Elevated lactate dehydrogenase
  • Bone marrow involvement
  • Altered mental status
  • Lab abnormalities
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4
Q

How do we diagnose DLBCL?

A
  • Lymph node biopsy (CD20)
  • PET/CT scan
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5
Q

A (high/low) IPI score indicates better outcomes

A

Low

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6
Q

What is are the preferred treatments for DLBCL?

A

R-CHOP and Pola-R-CHP

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7
Q

What are the drugs in R-CHOP?

A
  • Rituximab
  • Cyclophosphamide
  • Doxorubicin
  • Vincristine
  • Prednisone
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8
Q

What do we want to use instead of normal doxorubicin when LVEF <40%?

A
  • Liposomal doxorubicin
  • Gemcitabine
  • Etoposide
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9
Q

What should we give for DLBCL with concurrent CNS disease?

A

High-dose methotrexate

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10
Q

Why do we not go above 2mg with vincristine?

A

Peripheral neuropathy

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11
Q

What additional treatments can be considered with the CHOP regimen?

A
  • G-CSF for febrile neutropenia risk
  • Anti-emetics (high emetic risk regimen)
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12
Q

What is the lifetime maximum for doxorubicin?

A

450-500 mg/m^2

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13
Q

What is the titration protocol for with rituximab?

A

Prevent infusion reactions (6 hours)

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14
Q

What should we check before starting ANYONE on rituximab?

A

Hepatitis B panel

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15
Q

What should be given for patients with chronic HepB infection taking rituximab?

A

Entecavir 0.5 mg QD

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16
Q

When do we prefer DA-R-EPOCH?

A

Double/triple hit High Grade B-Cell Lymphomas
(C-MYC, BCL2, +/- BCL6)

17
Q

What do we consider when dose adjusting DA-R-EPOCH?

A

ANC -> increase doses as tolerated when above 500

18
Q

What MUST be given after completion of DA-R-EPOCH?

A

G-CSF for febrile neutropenia

19
Q

Why do we remove vincristine when adding polatuzumab vedotin?

A

Both cause peripheral neuropathy

20
Q

What are relapse/refractory options for DLBCL patients?

A
  • Salvage chemotherapy (R-ICE, GDP)
  • Autologous stem cell transplant
  • Chimeric Antigen Receptor Therapy (CAR-T)
  • Bispecific monoclonal antibody (BsAb)
21
Q

Symptoms occur in only about 30% of patients with CLL/SLL, but what might they have?

A
  • Enlarged lymph nodes
  • Enlarged spleen
  • B-symptoms
  • Cytopenias
  • Frequent infections
22
Q

Which CLL/SLL mutations indicate unfavorable outcomes?

A

del 17p and TP53

Look at for prognosis

23
Q

When do we treat CLL/SLL

A
  • Symptomatic
  • Threatened end organ function
  • Progressive bulky disease
  • Progressive bone marrow failure
  • Autoimmune anemia/thrombocytopenia not responsive to treatment
  • ALC >50%, LDT <6 months
  • Symptomatic extra-nodal involvement
24
Q

What fixed-duration treatment do we have for CLL/SLL?

A

Venetoclax + Obinutuzumab

25
Q

What indefinite treatment do we have for CLL/SLL?

A

Acalabrutinib + Obinutuzumab, Zanubrutinib, or Ibrutinib

26
Q

What are side effects we can expect with obinutuzumab?

A

Like rituximab but stronger
- Infusion reactions
- HepB reactivation
- Increased viral infection risk (acyclovir prophylaxis)

27
Q

What are the major side effects of ibrutinib?

A
  • Neutropenia
  • Afib
  • HTN
28
Q

What are the major side effects of acalabrutinib?

A

Headache musculoskeletal pain

29
Q

Which BTKi has the lowest risk for side effects?

A

Zanubrutinib

30
Q

T/F: Patients on BKTi inhibitors who have a spike in ALC are getting better

A

FALSE: it is transient and does not necessarily mean progression

31
Q

What is the major side effect of zanubrutinib?

A

Myelosuppression

32
Q

What do we look for to diagnose cHL?

A

Reed-Sternberg cells (mature B cell with 2 nuclei)

33
Q

What are the drugs in the ABVD treatment for Hodgekin’s Lymphoma

A
  • Doxorubicin
  • Bleomycin
  • Vinblastine
  • Dacarbazine
34
Q

What can we do to prevent bleomycin pulmonary toxicity with G-CSF?

A

PET-adapted approach

34
Q

Why do we avoid giving bleomycin and G-CSF?

A

Increase pulmonary toxicity risk

35
Q

What must we give with brentuximab with AVD chemotherapy?

A

G-CSF

36
Q

What options do we have for relapse/refractory treatment?

A
  • Salvage chemotherapy (R-ICE, GVD)
  • AutoHSCT
  • Immunotherapy (nivolumab, pembrolizumab)

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