lymphoma Flashcards by Katherine Lind

4 types of classical hodgkins

nodular sclerosing, mixed cellularity, lymphocyte predominant, lymphocyte depletd

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wha type of lymphoma is more common in kids <10 years

NHL

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most common caner in 15-19 yuaer olds

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most common cHL histology

Nodular sclerosino

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second most common CHL

mixed cellularity

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age and EBV status: mixed cellularity HL

< 10 years, usually +

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type of HL: reed Sternberg surrounded by lymphocytes, eosinophils, plasma cells, histiocytes

mixed

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type of HL: rS with background of small blue cells

lymphocyte rich

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what patients usually get lymphocyte depleted HL

adults with HIV, also usually EBV+

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what is non classic HL also called

nodular lymphocyte predominant

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which is + and - in Classic HL: CD15, 30, 45

YES 15 and 30l NOT 45

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which is + and - in nodular lymphocyte predimonant HL: CD15, 30, 45

not 15 or 30, yes 45

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EBV expression in HL- rank

LD> LR> MC> NS> NLP

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how does cHL have tumor resistance

1) MHC 1 expression ins low or absent 2) increased expression of PD1 and PD2 (via 9p24.1 alterations) which is why PD1 inhibitors are so good

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LP celll (formerly L&H) or popcorn cell is

NL predominant HL

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purpose of B symptoms in cHL and name 3

PROGNOSTIC (weight loss, night swats, unexplained fevers x 3 days)t

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treatment of stage IA NL predominant HL

surgery onlyu

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buzzwords for NL predominant HLO

YMCA- long male contained (localized) asymptomatic (usually no zB symptoms, not bulky)

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compare PET to BMA for HL

PET is more sensitive

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staging system of classical HL

Ann Arbor.
1. one node region or site 2. 2 node regions on same side of diagram 3. both sides of diaphragm. 4. diffuse/disseminated (liver/lung/marrow)

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unfavorable prognostic factors for peds HL

at dx: advanced dz, b symptoms, extra nodal extension, bulk studies. during therapy- slow orincompelte response

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what is brentuximab

anti-CD30 conjugated to MMAE

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what is the standard treatment for relapsed HL

high dose chemo, then auto transplant (usually). primary refractory disease doesn’t usually do well with autos

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who to treat with Brentux

classic HL (CD30)

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who to give ritux

CD20- give to NL PHL

name 2 PD1 inhibitors

nivolumab, pembrolizumab

most common secondary malignant post HL therapy

breast cancer- decreases with age (not an issue if age 30 or older)

greatest relative increase in risk for secondary malignancy post hL

leukemia

most common NHL in peds

burkiitts

Ki-67+ staining is common in

highly proliferative cells like burkitts where it is >99%. still there for DLBCL but is less than 90

key burkitts trnaslocations (there are 2 common ones)

t(8;14) > (8;22) or (8;2)

lymphoma with CD 19 20 22 79a PAX-5 and surface IgG+ surface IgM

DIFFUSE LARGE B CELL

Gene profile of primary mediastinal B cell lymphoma overlaps with what

cHL (shares >1/3 genes)

immunophenotype of anapestic large cell lymphoma

CD30+, NEGATIVE For 15 and 45. 60% have T cell markers

anaplastic large cell lymphoma translocation

t(2;5)(p23:35)- NPM ALK fusion

ALCL vs cutaneous lypphoa is different how

cutaneous is ALK negative and easy to treat, usually derm alone

intussusception is what 2 types of lymphoma usually

burkitts or DLBCL

presentation: Slowly progressive, systemic symptoms, organs and skin, nodal, extranodal Can be very aggressive, with inflammatory response and HLH Advanced disease in 2/3, but CNS and marrow are rare

ALCL

classification for NHL

St Jude (murphy)

key difference in Murphy and AA staging

in Murphys abdome and GI are automatically stage 2

French stratification of mature B cell lymphoma- what is stratum C

CNS+ or >25% marrow

treat burritos leukemia like

like burkitts lymphoma

treat lymphoblastic lymphoma lie

chemo for ALL- 2 years

rite improves outcomes for high stages of what 2 diseases

burkitts, DLCL

treatment for PMBCL includes

ritux

bortesomib treats

T-LLy

bulk disease is only prognostic when

peds HL

NHL age is when

< 10 years

CNS pox for what

Non HL

what lymphoma gets radiation

nelarabine mechanism

purine analog- for T cell ALL

bortezomi mechanism

proteasome inhibitor blocks degradation of 1 kappa Beta

define very early, early, ad late release with Lymphoma

very early is <3 mo, early is 3mo-1 year

popcorn cell

NL PLPHD

2 driving pathways in HL

NFkappa zB and JAK/STAT

Hodgkin lymphoma- 2 mechanisms of immune evasion

doesn't express MHC class 1 and expresses a ton of PD1 ALTERATIONS THAT MAKES IT SO T CELLS CANT KILL IT.

what is complete metabolic response in PET

1,2,3- JUST LESS THAN LIVER

4 unfavorable prognostic factors at diagnosis for HL

advanced disease, B symptoms, extra nodal extension and bulk disease

does pediatric HL get CNS therapy

3 fields of radiation therapy for Hodgkins -- list from largest area treated to smallest

mantle field, involved field, and involved node

3 key translocations for burkitts

1) IGH-cMYC (t 8;14)(q24;q32) 2) IGkappa-cMYC (t2;8)(p11q24) and 3) ig-gamma-cMYC (8;22)(q24;q11)

type of cells in burkitts

mature germinal center B cell (no Tdt)

how do you treat burrito leukemia

like LYMPHOMA not ALL

Presentation: jaw swelling, orbital swelling, paradpinal mass, CNS marrow and intusussception

endemic burkitts

rapidly expanding abdominal mass, spontaneous tumor lysis, marrow, CNS, nonspecific GI, intusussception

sporadic burkitts

diverse- LN, liver, spleen, marrow, medisatinam, extra nodal abdominal, often advanced stage

DLBCL

intussusception is what 2

DLBCL and burkitts

mediastinal mass, local invasion, respiratory symptoms, SVC syndrome

primary mediastinal b celm

mediastinal mass with pleural and pericardial effusions, pain, dysphagia, dyspnea

lymphoblastic lymphoma

slowly progressive systemic symptoms, organ and skin, can be aggressive with inflammatory response and HH. advanced disease in 2/3 but rare ZCNS and marrow

ALCL

key difference in Murphy stage 1 vs Ann arbor

in murphy, stage 1 cannot be mediastinum a d abdomen

Murphy staging for primary GI tumor that is resectable

what stage in Murphy is primary intrathoracic, abdominal, paraspinal, or epidural even if only in those spots

what is group C for burkitts and ZDLBCL

CNS+ or more than 25% blasts in marrow

what peds NHL does not get CNS ppx

resected abdominal burkit/DLBCLw

what type of peds NHL gets radiation

CNS+ lymphoblastic lymphoma

horseshoe or hallmark cell

all

NHL with low MHC I

PMBCL

lymphoma with low MHC1

cHL

brentux for what

cHL and ALCL

rituxumab for what

NL PHD, burkitt, DLBCL, PMBCL

nelarabine for what

T cell ALL

what pediatric NHL does not need chemo

fully resected peds follicular

what NHL does NOT need CNS ppx

fully resected abdominal burkitts and ZDLBCL

what NHL does need radiation

CNS+ Lay

most peds NHL is short and intense Rx except

LLY

who needs marrows in pediatric lymphoma

NHL

who needs CSF eval and ppx in peds lymphoma

NHL