Lymphoma Flashcards
Lymphomas are malignant neoplasms that originate from the ___.
Lymphoid tissues
What are the 2 distinct categories of lymphoma? How are they different?
Hodgkin and non-Hodgkin; different morphologic characteristics, clinical behavior, response to Rx
How can you distinguish between types of lymphoma?
Surgical biopsy (cannot differentiate on clinical grounds)
In the diagnosis of a suspected lymphoma, what kind of biopsy should be done and why?
Excisional biopsy of the entire lymph node or nodes is imperative, as the architecture has a bearing on dx and treatment
Population typically affected by Hodgkin lymphoma?
May occur at any age, but generally a disease of young adults; prevalence in women peaks in the 3rd decade and then falls, while it remains fairly constant in men
Pathologic dx findings of Hodgkin lymphoma?
Reed-Sternberg cells in an appropriate cellular background of reactive leukocytes and fibrosis
What determines the subtype of Hodgkin disease?
Pattern of lymphocytic infiltrate
Modern therapy has wallowed for a cure of over ___% of patients with Hodgkin lymphoma.
70
Presentation of patients with Hodgkin lymphoma?
Most present with enlarged but painless lymph nodes, typically in the lower neck or supraclavicular region
On occasion, mediastinal masses are associated with cough or dyspnea or discovered on routine CXR
About 25% have systemic symptoms (B symptoms - weight loss, pruritus, fever, drenching night sweats)
What is the most important prognostic factor in Hodgkin lymphoma?
Disease stage
What is the major means of staging intrathoracic and intra-abdominal disease?
CT chest, abdomen, pelvis
___ is also part of the staging evaluation of patients with bony symptoms or cytopenias.
BM biopsy
What has recently become a standard staging tool both before treatment and at completion?
Fluorodeoxyglucose F 18 (FDG-PET) scan
In the past, what was used to stage abdominal disease in Hodgkin lymphoma?
Staging laparotomy with splenectomy, wedge liver biopsy, and dissection of the para-aortic, iliac, splenic, hilar, and hepatic portal lymph nodes
For patients with favorable prognosis stage I-II Hodgkin lymphoma, treatment typically involves what?
Combination of ABVD chemo (doxorubin, bleomycin, vinblastine, dacarbazine) in combination with involved field irradiation
(Unfavorable -> more cycles)
For patients with stage III-IV Hodgkin lymphoma (advanced stage), treatment involves what?
Newer regimens include escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) and Stanford V (doxorubicin, vinblastine, mechlorethamine, vincristine bleomycin, etoposide, prednisone)
Consolidation radiotherapy may be considered with ABVD or BEACOPP;e ssential with Stanford V
Approximately ___% of patients are refractory to initial therapy and ___% will relapse after complete remission. What are the next steps?
5-10; 10-30
Salvage therapy with an alternate chemo regimen
High-dose chemo and autologous HCT if early relapse (within 12 months), second relapse, or a generalized systemic relapse, even afer 12 months
Compare the prevalence of NHL to Hodgkin vis a vis age.
As opposed to HL, the prevalence of NHL rises with age.
Risk factors for NHL?
Congenital disorders such as ataxia-telangiectasia, Wiskott-Aldrich syndrome, celiac disease
Acquired conditions such as prior chemo or radiation, immunosuppressive therapy, EBV infection, HIV infection, HTLV-1 infection, H. pylori gastritis, Hashimoto, and Sjogren syndrome
NHL may originate from what types of cells?
B, T, or histiocytes
Presentation of NHL?
Classically presents as non-tender enlargement of LN, but nearly 1/3 of all cases originate outside the LN - these extranodal malignancies develop in organs that normally have nests of lymphoid tissue (muocsal surfaces, bone marrow, skin)
What is the goal of staging evaluation in NHL?
Distinguish patients who have localized disease from those with disseminated disease
After pathologic diagnosis, the staging evaluation for NHL consists of what?
Detailed H&P Routine labs BM biopsy CT nekc, chest, abdomen, pelvis Evaluation of CSF if diffuse large-cell NHL with bone marrow involvement, high LDH, or multiple extranodal sites of disease FDG-PET scans
Rx indolent localized lymphoma?
Radiation therapy only with curative intent
Rx indolent disseminated lymphoma?
Current therapies are rarely curative, goal of treatment is palliation of symptoms; “watch and wait” approach in asymptomatic patients
Symptomatic - rituximab + alkylator chemotherapy - high response rates and can alleviate symptoms
Rx aggressive low-risk lymphoma?
CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) + rituximab
Radiotherapy after chemo for areas of bulky disease
Rx aggressive high-risk lymphoma?
More intensive chemo + rituximab and potentially high-dose therapy with HCT
