Lymphoma

Question 1

4 subtypes of HL?

Answer 1

Nodular sclerosis, lymphocyte predominant, lymphocyte depleted, mixed cellularity

Question 2

Prognosis of HL depends on?

Answer 2

Depends more on stage than type of HL

Question 3

What type of cell is present in HL? What is this cell predominantly derived from?

Answer 3

Reed-Sternberg cell; nearly all from B cells

Question 4

Name the staging classifications for HL?

Answer 4

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)

Question 5

Treatment for limited stage (Stage I/II, no B or bulky tumor?

Answer 5

Chemotherapy followed by radiation

Question 6

Treatment for advanced stage (Stage III/IV, B signs, bulky tumor)?

Answer 6

Multi agent chemotherapy. ABVD.

Adriamycin, Bleomycin, Vinblastine, Dacarbazine. Given every 2 months for 6 cycles. Goal is cure!

Question 7

Complications of treatment?

Answer 7

Fertility issues, cardiac toxicity, secondary malignancies, immune dysfunction, pneumonitis, avascular neocrosis, dental carries, hypothyroidism

Question 8

Which is more common, HL or NHL?

Answer 8

NHL

Question 9

Types of non-Hodgkins lymphoma?

Answer 9

Diffuse large B cell lymphoma (curable), Follicular lymphoma `(non-curable)

Question 10

Clinical presentation of DLBCL?

Answer 10

Rapidly advancing symptomatic mass (neck, abdomen), B symptoms, elevated LDH

Question 11

Initial labs and test for DLBCL?

Answer 11

CBC, CMP, LDH, Hep B, Uric Acid. BM aspiration/biopsy, baseline cardiac assessment prior to anthracycline, CT/PET/CT

Question 12

Staging for DLBCL and FL?

Answer 12

Staging is the same for HL except for A/B symptoms

Question 13

What are A and B symptoms?

Answer 13

A-asymptomatic. B- fever, night sweats, weight loss

Question 14

Treatment for limited stage (I or II) DLBCL?

Answer 14

Radiation alone, limited chemo (3-4 cycles) followed by involved field XRT, full course chemo

Question 15

Treatment of advanced stage (III/IV) DLBCL?

Answer 15

Chemo and immunotherapy. R-CHOP. Rituximab (monoclonal antibody), Cyclophosphamide, Hydroxydaunorubicin, Oncovorin, Prednisone. Goal is to cure. Every 3 weeks for 6 cycles

Question 16

What do you want to completed during chemo treatment and at the end?

Answer 16

PET/CT 2-3 weeks into treatment. 6-8 weeks following completion. Repeat BM biopsy if +

Question 17

When would symptoms of relapse generally present?

Answer 17

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

Question 18

How would someone with Follicular lymphoma present?

Answer 18

Indolent lymphoma (little or no pain). Asymptomatic peripheral lymphadenopathy that wax and wane. Large abdominal masses. Usually present in advanced stage

Question 19

Initial evaluation for FL?

Answer 19

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

Question 20

FL treatment for early stage FL?

Answer 20

Consider FL XRT alone, no benefit of chemo, can observe

Question 21

Indications for treatment in advanced stage FL?

Answer 21

Symptoms, steady progression, bulky disease, threatened end organ function, cytopenia secondary to lymphoma

Question 22

Advanced stage FL treatment?

Answer 22

Rituximab single agent. Combined immuno and chemo- R-CHOP or BR (bendamustine and rituximab). Radioimmunotherapy- Ibritumomab tiuxetan or Tositumomab

Question 23

Complications of BM failure in NHL?

Answer 23

Anemia and thrombocytopenia