Lymphoma Flashcards
4 subtypes of HL?
Nodular sclerosis, lymphocyte predominant, lymphocyte depleted, mixed cellularity
Prognosis of HL depends on?
Depends more on stage than type of HL
What type of cell is present in HL? What is this cell predominantly derived from?
Reed-Sternberg cell; nearly all from B cells
Name the staging classifications for HL?
Stage I- single node/region. Stage II- 2 or more nodal regions on same side. Stage III- nodal regions on both sides of diaphragm (includes spleen). Stage IV- diffuse involvement, visceral involvement (BM, liver). A (asymptomatic) vs B (symptomatic)
Treatment for limited stage (Stage I/II, no B or bulky tumor?
Chemotherapy followed by radiation
Treatment for advanced stage (Stage III/IV, B signs, bulky tumor)?
Multi agent chemotherapy. ABVD.
Adriamycin, Bleomycin, Vinblastine, Dacarbazine. Given every 2 months for 6 cycles. Goal is cure!
Complications of treatment?
Fertility issues, cardiac toxicity, secondary malignancies, immune dysfunction, pneumonitis, avascular neocrosis, dental carries, hypothyroidism
Which is more common, HL or NHL?
NHL
Types of non-Hodgkins lymphoma?
Diffuse large B cell lymphoma (curable), Follicular lymphoma `(non-curable)
Clinical presentation of DLBCL?
Rapidly advancing symptomatic mass (neck, abdomen), B symptoms, elevated LDH
Initial labs and test for DLBCL?
CBC, CMP, LDH, Hep B, Uric Acid. BM aspiration/biopsy, baseline cardiac assessment prior to anthracycline, CT/PET/CT
Staging for DLBCL and FL?
Staging is the same for HL except for A/B symptoms
What are A and B symptoms?
A-asymptomatic. B- fever, night sweats, weight loss
Treatment for limited stage (I or II) DLBCL?
Radiation alone, limited chemo (3-4 cycles) followed by involved field XRT, full course chemo
Treatment of advanced stage (III/IV) DLBCL?
Chemo and immunotherapy. R-CHOP. Rituximab (monoclonal antibody), Cyclophosphamide, Hydroxydaunorubicin, Oncovorin, Prednisone. Goal is to cure. Every 3 weeks for 6 cycles
What do you want to completed during chemo treatment and at the end?
PET/CT 2-3 weeks into treatment. 6-8 weeks following completion. Repeat BM biopsy if +
When would symptoms of relapse generally present?
Within the first 2 years. Want to follow up with patient every 3 months in 1st 2 years and then every 6 months. Relapses are generally symptomatic
How would someone with Follicular lymphoma present?
Indolent lymphoma (little or no pain). Asymptomatic peripheral lymphadenopathy that wax and wane. Large abdominal masses. Usually present in advanced stage
Initial evaluation for FL?
CBC, CMP, LDH, beta 2 microglobulin, Hep B, BM asp/biopsy, CT of chest, abdomen, pelvis with IV contrast or PET/CT, baseline cardio testing
FL treatment for early stage FL?
Consider FL XRT alone, no benefit of chemo, can observe
Indications for treatment in advanced stage FL?
Symptoms, steady progression, bulky disease, threatened end organ function, cytopenia secondary to lymphoma
Advanced stage FL treatment?
Rituximab single agent. Combined immuno and chemo- R-CHOP or BR (bendamustine and rituximab). Radioimmunotherapy- Ibritumomab tiuxetan or Tositumomab
Complications of BM failure in NHL?
Anemia and thrombocytopenia
