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Heme - Wier/Pallera > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

**What 4 major factors must a doctor consider when he/she decides if cure is possible for a patient with lymphoma?

A
  1. Tumor Histology
  2. Tumor Stage
  3. Condition of Patient
  4. Available Therapies
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2
Q

**Name the most common indolent lymphoma.

The most aggressive lymphoma?

A

Most Common Indolent Lymphoma:
- FOLLICULAR LYMPHOMA

Most Common Aggressive Lymphoma:
- DIFFUSE LARGE B CELL (DLBC) Lymphoma

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3
Q

**What staging is used with the different types of lymphoma?

A

IPI - 4 stage system is used with all lymphomas BOTH Hodgkins and Non-Hodgkins

RAI - used for CLL

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4
Q

**What is the mechanism and site of action for rituximab?

• Ibrutinib?

A

Rituximab
• Binds to CD20
• Fc region recognized by MACROPHAGES, NK CELLS, and C3 complement

Ibrutinib
• Inhibits BTK in the B-cell receptor pathway

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5
Q

**What is the name of the most common cutaneous lymphoma and what cell can you find in the blood of some of these patients?

A

Mycosis Fungiodes

*If this has progressed to SEZARY you’ll find malignant T cells in their blood

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6
Q

**What is a common complication of radiation therapy in young Hodgkin’s Lymphoma Women?

A

Breast Cancer

possible infertility

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7
Q

**What are the two complications of CLL (chronic lymphocytic leukemia)?

A

OFTEN Asymptomatic BUT sometimes show complications

Complications:
• ANEMIA***From bone marrow replacement OR AUTOIMMUNE HEMOLYTIC ANEMIA
• SPLENOMEGALY
• THROMBOCYTOPENIA 
• Hypogammaglobulinemia
• Lymphocytosis
• Lymphadenopathy
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8
Q

**What are some poor prognostic abnormalities in CLL?

A

Deletion of 17p

Deletion of 11q

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9
Q

**When is BMT (bone marrow transplant) used in lymphomas?

A

Used after RELAPSE
*allows them to give you insanely high doses of chemo that almost cause bone marrow failure

*Autologous transplants are often performed by kicking a patients blasts out into peripheral blood so you don’t have to do a bone marrow biopsy for a transplant

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10
Q

What determines what kind of lymphoma you have (at the most fundemental level)?

A

The site of B-cell arrest

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11
Q

What are some symptoms/complications of the actual masses of cells that have proliferated in lymphomas?
• What issues are you likely to see on CBC?

A

Masses of Cells cause:
• Lymphadenopathy
• Ureteral Obstruction (uric acid)
• Spinal Cord Compression

Issues on CBC:
•Pancytopenia

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12
Q

What paraneoplastic syndromes are associated with lymphomas?

A
  • Autoimmune Hemolytic Anemia
  • Immune Thrombocytopenia Purpura
  • Neuropathy
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13
Q

T or F: monoclonal expansions of lymphocytes can cause hypogammaglobulinemia by causing there to be less diversity in the B cell repertoire.

A

True, I THINK, Hypogammaglobulinemia is definitely a complication of lymphomas though (per Wier)

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14
Q

In what 3 ways may you be able to help a lymphoma pt. even if you can’t cure their disease?

A
  1. Help them liver longer
  2. Improve Quaility of Life
  3. Prevent disaster that may happen from tumor mass
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15
Q

What categorizations do we give to Lymphomas to get an idea of how they will behave?

A
  1. Indolent
  2. Aggressive
  3. Highly Aggressive
  4. B or T cell
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16
Q 
*What can be said about the following factor for an indolent lymphoma? 
• Stage 
• Progression
• Response to Therapies 
• Curability 
• Survival and Early Intervention
• WHEN to treat
A

INDOLENT LYMPHOMAS
• Stage: HIGH
• Progression: SLOW
• Responds to SIMPLE therapies
• Curability: NOT VERY CURABLE UNLESS IN STAGE I or II
• Early Intervention: DOES NOT really affect pt. survival
• Treatment: ONLY WHEN SYMPTOMATIC

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17
Q

What are the 4 most common type of indolent lymphoma?

• Which is most prevalent?

A
  1. FOLLICULAR lymphoma (most prevalent)
  2. CLL CHRONIC LYMPHOCYTIC LEUKEMIA/ SLL
  3. MALT lymphomas
  4. Mycosis Fugoides
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18
Q

Where do you commonly see MALT lymphomas?

A

GI Tract and SCLERA

19
Q 
* Compare the following factors in a high grade AGGRESSIVE lymphoma to an indolent lymphoma. 
• Stage 
• Progression
• Response to Therapies 
• Curability 
• Survival and Early Intervention
• WHEN to treat
A
  • Stage: Lower stage (1 or 2)
  • Progression: RAPID
  • Responds to COMPLEX therapies
  • VERY CURABLE - with aggressive therapy early on
  • Early Therapy Required - DO NOT WAIT FOR SYMPTOMS
20
Q

• Define stages I-IV in lymphoma.

A

Stage I:
Single Node or Lymphoid Structure involved

Stage II:
Two or More lymph regions on ONE SIDE OF DIAPHRAGM

Stage III:
BOTH sides of DIAPHRAGM affected

Stage IV:
Extranodal - disease has metastasized out of nodes

21
Q

T or F: you can have stage I and II extranodal cancers if the cancer arises outside of lymph nodes and spreads only to adjacent lymph nodes

A

True, this is Stage I or II “E”

22
Q

When Lymphomas metastasize outside of lymph nodes where are they most likely to go?

A
  • Liver
  • Spleen
  • Bone marrow
23
Q

T or F: we stage Hodgkin and Non-Hodgkins lymphomas the same way

A

TRUE

24
Q

What tests will you do to try and stage someone’s lymphoma?

A
  • History and Exam
  • CAT scan chest, abdomen, and Pelvis
  • Bone marrow aspirate and biopsy with flow cytometry
  • PET scans
  • Chemistries, CBC, LDH
  • CSF
25
Q

When would you do a spinal tap to see if someone has metastasis to the meninges or not?

A

only test CSF if high risk

26
Q

What the point of doing both a PET scan and a CAT scan.

A
  • In addition to seeing nodules PET scans will detect the level of activity in lymph nodes/affected sites.
  • Can ALSO detect cancer growing the bone marrow which isn’t readily detected by a CAT scan

**We do this by giving the patient Sucrose then tracking areas of high sucrose metabolism

27
Q

T or F: Follicular lymphoma and Chronic Lymphocytic Lymphoma would show up brightly on a PET scan.

A

FALSE, these are indolent, slowly progressing cancers, thus it is unlikely that they would metabolize fast enough to see any real difference on the PET scan

28
Q

How do you acquire the numbers to determine a patients 5 year survival rate for lymphomas?
• what lymphoma is not graded this way?

A

Use APLES, each positive category counts as a point

Age>60 = 1 
Stage III or IV = 1
LDH elevated = 1
Performance Status > 1 = 1
Extranodal Sites > 1 = 1

***For those that are > 1 (P status and Extranodal sites) add 1 for every node for E-sites

29
Q

Based on the International Prognostic Index (IPI) what grades determine if a patient is Low, Low Intermediate, High Intermediate, or High Risk?
• Predict the Pts. 5 yr. survival based on this risk.

A

Low Risk: 0-1 = 73% % 5yr survival
Low Intermediate Risk: 2 = 51% 5yr survival
High Intermediate Risk: 3 = 43% 5yr survival
High Risk: 4-5 26% 5yr survival

30
Q

WHEN INDOLENT LYMPHOMAS become symptomatic, what therapies do we use?

A
  • Local Irradiation (treat symptomatic areas)
  • Alkylators and Prednisone
  • Anthracyclins (DOXYRUBICIN)
  • Fludarabine (purine analog)
  • Antibody Therapy
  • Radiation Labeled Antibodies

COMBINATION THERAPIES
• CHOP (cyclophosphamide, hydroxydaunrubicin, oncovin, and prednisone)
• Fludarabine + Mitoxantrone

31
Q

What does CHOP therapy stand for?

A

CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone)

*note: oncovin = vinblastin

32
Q

What Therapies might you consider for an aggressive lymphoma?

A

**Remember aggressive cancer, aggressive treatment
COMBINATION CHEMOTHERAPIES
• CHOP, HyperCVAD
• Ab. therapy (rituximab) + CHOP
• Radio-immunotherapy
• Short course chemo and radiation for (Stage I and II)

RELAPSE:
• BONE MARROW TRANSPLANT (autologous or allogeneic)

33
Q

T or F: there is no evidence to support that using rituximab with CHOP therapy is beneficial.

A

FALSE, in R-CHOP therapy there is a much greater chance or the patient surviving more than 5 years

34
Q

What are your options after lymphoma relapse?

• which has been shown to improve survival rate?

A

2 line chemo or Bone marrow transplant (autologous or allogenic)

Survival Rate Better with BMT

35
Q

What does aletuzumab target?

• which cell types is this found on?

A

CD52 found on B and T cells

**Note: this drug causes severe immunosuppression

36
Q 
**What lymphomas are associated with the following infections? 
• HIV
• HH8
• HTLV-1
• EBV
• H. Pylori
A 
HIV - Primary CNS lymphomas 
HH8 - primary plural effusion lymphomas (and kaposi's)
HTLV-1 - T cell Lymphomas
EBV - Burkitt's Lymphoma
H. Pylori - MALT lympomas
37
Q

Where would you be most likely to see someone with an HTLV-1 infection

A

Japan
Caribbean
Southern USA

38
Q

**What are the 4 types of Hodgkins Lymphomas?
• Best Px –> Worst Px
• Adults vs. Kids

A 
Kids: 
Lymphocyte Rick (BEST Px)
Nodular Sclerosis (Good Px) 
Adults: 
Mixed Cellularity (Not Good Px)
Lymphocyte Depleted (BAD Px)
39
Q

How does the mode of progression of Hodgkin’s differ from most cancers?
• How does staging differ?

A

Moves from one node to the next so that you can predict its progression.

**STAGING IS THE SAME IN EVERY WAY for Hodgkin and Nonhodgkins

40
Q

What treatment if given to people with late stage Hodgkins?

A

ABVD - CHEMOTHERAPY

Adreomycin
Bleomycin or Brentuximab
Vinblastin
DTIC (dacarbazine)

41
Q

What does Brentuximab target?

A

CD30

42
Q

What is a common problem that people who have been cured of Hodgkins are now facing as they grow older?

A

They are Developing NEW Cancers as a result of Treatment

  • Acute Leukemias and Myelodysplasias
  • Solid Breast, Lung, stomach, bone, tumors
  • CORONARY ARTERY DISEASE
  • INFERTILITY
  • Hypothyroidism
43
Q

**What method of staging is used for CLL?

• when do we treat?

A

**RAI method is used

DON’T treat stage 0, 1,and 2, Treat 3 and 4

0 - lymphocytosis
1 - enlarged nodes
2- hepatosplenomegaly
3 - Hgb below 10 (non-immune) 
4 - Platelets (less than 100,000; non-immune mediated)

Heme - Wier/Pallera (12 decks)

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