Lymphoma Flashcards
What are risk factors for lymphoma?
- Male gender
- Older age
- Immunosuppression
- Infections
- Environmental exposures
- Radiation exposure
- Epstein-Barr Virus
- HIV infection
What are B-symptoms?
- Fever
- Night sweats
- Significant weight loss
What are symptoms of DLBCL?
- B-symptoms
- Nodal mass
- Elevated lactate dehydrogenase
- Bone marrow involvement
- Altered mental status
- Lab abnormalities
How do we diagnose DLBCL?
- Lymph node biopsy (CD20)
- PET/CT scan
A (high/low) IPI score indicates better outcomes
Low
What is are the preferred treatments for DLBCL?
R-CHOP and Pola-R-CHP
What are the drugs in R-CHOP?
- Rituximab
- Cyclophosphamide
- Doxorubicin
- Vincristine
- Prednisone
What do we want to use instead of normal doxorubicin when LVEF <40%?
- Liposomal doxorubicin
- Gemcitabine
- Etoposide
What should we give for DLBCL with concurrent CNS disease?
High-dose methotrexate
Why do we not go above 2mg with vincristine?
Peripheral neuropathy
What additional treatments can be considered with the CHOP regimen?
- G-CSF for febrile neutropenia risk
- Anti-emetics (high emetic risk regimen)
What is the lifetime maximum for doxorubicin?
450-500 mg/m^2
What is the titration protocol for with rituximab?
Prevent infusion reactions (6 hours)
What should we check before starting ANYONE on rituximab?
Hepatitis B panel
What should be given for patients with chronic HepB infection taking rituximab?
Entecavir 0.5 mg QD
When do we prefer DA-R-EPOCH?
Double/triple hit High Grade B-Cell Lymphomas
(C-MYC, BCL2, +/- BCL6)
What do we consider when dose adjusting DA-R-EPOCH?
ANC -> increase doses as tolerated when above 500
What MUST be given after completion of DA-R-EPOCH?
G-CSF for febrile neutropenia
Why do we remove vincristine when adding polatuzumab vedotin?
Both cause peripheral neuropathy
What are relapse/refractory options for DLBCL patients?
- Salvage chemotherapy (R-ICE, GDP)
- Autologous stem cell transplant
- Chimeric Antigen Receptor Therapy (CAR-T)
- Bispecific monoclonal antibody (BsAb)
Symptoms occur in only about 30% of patients with CLL/SLL, but what might they have?
- Enlarged lymph nodes
- Enlarged spleen
- B-symptoms
- Cytopenias
- Frequent infections
Which CLL/SLL mutations indicate unfavorable outcomes?
del 17p and TP53
Look at for prognosis
When do we treat CLL/SLL
- 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
What fixed-duration treatment do we have for CLL/SLL?
Venetoclax + Obinutuzumab
What indefinite treatment do we have for CLL/SLL?
Acalabrutinib + Obinutuzumab, Zanubrutinib, or Ibrutinib
What are side effects we can expect with obinutuzumab?
Like rituximab but stronger
- Infusion reactions
- HepB reactivation
- Increased viral infection risk (acyclovir prophylaxis)
What are the major side effects of ibrutinib?
- Neutropenia
- Afib
- HTN
What are the major side effects of acalabrutinib?
Headache musculoskeletal pain
Which BTKi has the lowest risk for side effects?
Zanubrutinib
T/F: Patients on BKTi inhibitors who have a spike in ALC are getting better
FALSE: it is transient and does not necessarily mean progression
What is the major side effect of zanubrutinib?
Myelosuppression
What do we look for to diagnose cHL?
Reed-Sternberg cells (mature B cell with 2 nuclei)
What are the drugs in the ABVD treatment for Hodgekin’s Lymphoma
- Doxorubicin
- Bleomycin
- Vinblastine
- Dacarbazine
What can we do to prevent bleomycin pulmonary toxicity with G-CSF?
PET-adapted approach
Why do we avoid giving bleomycin and G-CSF?
Increase pulmonary toxicity risk
What must we give with brentuximab with AVD chemotherapy?
G-CSF
What options do we have for relapse/refractory treatment?
- Salvage chemotherapy (R-ICE, GVD)
- AutoHSCT
- Immunotherapy (nivolumab, pembrolizumab)
