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clin med IV > lymphoma > Flashcards

lymphoma Flashcards

1
Q

multiple myeloma

A
  • increased production of non- functioning plasma cells

- plasma cells produce IgG with excess light chains

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2
Q

RF for MM

A
  • usu dx in 60s
  • no clear RF
  • assoc with woodworkers, farmers, leather craftsmen
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3
Q

si/sx of MM

A
  • bone pain*
  • weakness, fatigue, wt loss
  • dyspnea
  • fever
  • repeated infx
  • SC compression
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4
Q

PE findings for MM

A
  • pallor
  • organomegaly
  • radiculopaty
  • peripheral neuropathy
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5
Q

lab findings for MM

A
  • hyper Ca
  • increased serum proteins
  • anemia
  • ARF
  • low anion gap
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6
Q

major criteria for MM dx

A
  • plasmacytosis on tissue bx
  • BM > 30% plasma cells
  • M spike on SPEP or UPEP
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7
Q

M spike levels that are diagnostic for MM

A
  • IgG > 35 on SPEP
  • IgA > 20 on SPEP
  • > 1g/24 hours on UPEP
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8
Q

minor criteria for MM dx

A
  • BM 10-30% plasma cells
  • M spike lower than major criteria
  • lytic bone lesion on xray
  • abnormally low immunoglobulin levels
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9
Q

dx of MM

A
  • 1 major + 1 minor criteria
    OR
  • 3 minor criteria
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10
Q

what is the classic triad of MM

A
  • lytic lesions
  • BM plasma > 30%
  • M spike on SPEP or UPEP
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11
Q

what are bad prognostic indicators for MM

A
  • “CRAB”
  • hyperCalcemia
  • renal failure
  • anemia
  • boney lytic lesions
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12
Q

what staging criteria are used for MM

A
  • durie salmon (I-IIIb)

- international staging systems ( I-III)

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13
Q

tx for MM

A
  • no cure
  • low threshold for infx- treat infx
  • HSCT gives pt 5 extra years
  • analgesia
  • hydration
  • plasmapheresis
  • xrt
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14
Q

prognosis of MM

A
  • fatal within 4-5 years without HSCT

- death d/t progression, renal failure, sepsis, tx related leukemia or myelodisplasia

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15
Q

what is MGUS

A
  • “pre-MM”
  • M spike
  • no sx
  • < 10% plasma cells
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16
Q

what is smoldering MM

A
  • “pre-MM”

- meets dx criteria for MM but no end organ damage

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17
Q

essential thrombocytosis

A
  • myeloproliferative disorder
  • produce too many dysfunctional platelets
  • usu dx incidentally
  • tx: plasmapheresis
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18
Q

what is the most common hematologic malignancy

A
  • non-hodgkins lymphoma

- common in adults > 50

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19
Q

non-hodkins lymphma (NHL)

A
  • over 35 dif types
  • majority are B cell
  • classified as indolent, aggressive, or highly aggressive
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20
Q

indolent NHL

A
  • follicular

- survival is years if untreated

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21
Q

aggressive NHL

A
  • Diffuse large B cell lymphoma (DLBCL)

- survival is months if untreated

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22
Q

highly aggresive NHL

A
  • burkitts lymphoma

- survival is weeks if untreated

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23
Q

RF for NHL

A
  • family hx
  • prev xrt or chemo
  • immunosuppressives
  • HTLV1, HIV, EBV, Hep B/C
  • inflammatory GI disease
  • autoimmune disorders
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24
Q

si/sx of NHL

A
  • unexplained fever*
  • night sweats, fatigue, wt loss
  • painless LAD
  • cough or CP
  • bloating
  • rashes
  • hepato/ splenomegaly
25
Q

extranodal involvement in NHL

A
  • CNS
  • bone
  • GIT
  • dermis
  • testicular- most common testitcular ca if > 60
  • waldeyer’s ring
26
Q

dx of NHL

A
  • excisional LN bx
  • bone marrow aspiration
  • LP if suspect CNS involvment
  • PET for staging
27
Q

prognosis of NHL

A
  • determined by:
  • immunophenotype
  • cytogenetics
  • growth fraction
  • cytokine production
28
Q

staging I lymphoma

A
  • disease in single region
29
Q

stage II lymphoma

A
  • 2+ LN on same side of diaphragm
30
Q

stage III lymphoma

A
  • LN above and below diaphragm
31
Q

stage IV lymphoma

A
  • widespread disease

- multiple organs

32
Q

modified ann arbor staging

A
  • used for lymphoma
  • e= extranodal
  • s= spleen
  • x= bulky LN > 10 cm
33
Q

follicular NHL

A
  • indolent
  • grows/ spreads slowly
  • second most common type of NHL
34
Q

what causes follicular NHL

A
  • translocation between chromosome 14 and 18 -> BCL2 gene

- cells dont undergo apoptosis

35
Q

prognosis of follicular NHL

A
  • based on flipi score
  • nodal involvement
  • LDH level
  • age > 60
  • stage III or IV disease
  • Hgb < 12
36
Q

diffuse large B cell lymphoma (DLBCL)

A
  • aggressive NHL

- most common type of NHL

37
Q

what usu causes DLBCL

A
  • long term immunosuppressive tx
38
Q

cell markers for DLBCL

A
  • CD19
  • CD20
  • CD79a
39
Q

tx for DLBCL

A
  • everyone gets chemo
  • stage I and II: 3-4 cycles
  • stage III and IV: 6-8 cycles
40
Q

tx for follicular NHL

A
  • stage I and II: xrt

- stage III and IV: chemo

41
Q

burkitt’s lymphoma

A
  • highly aggressive NHL

- affects kids in Africa

42
Q

si/sx of burkitt’s lymphoma

A
  • mandibular/ facial bone tumor
  • may have abd mass with ascites
  • renal and testicular involvement
  • spreads to CNS and bone marrow
  • can be assoc with HIV
43
Q

dx of burkitt’s lymphoma

A
  • starry sky appearance on bx

- MYC translocation- chromo 8 and 24

44
Q

prognosis of burkitt’s

A
  • rapidly fatal if untreated

- good prognosis/ cure rates with tx

45
Q

T cell lymphoma

A
  • uncommon type of NHL

- have a lot of cutaneous invovement

46
Q

subtypes of T cell lymphoma

A
  • precursor T lymphoblastic lymphoma

- peripheral T lymphoma

47
Q

tx of T cell lymphoma

A
  • topical: cutaneous and oral disease modifiers
  • systemic: poor outcomes -> early clinical trials, combo chemo, novel biologics
  • Car T cell tx
48
Q

hodgkin’s lymphoma

A
  • reed sternberg cells
  • potentially curable
  • subclassified as classical vs nodular lymphocyte predominant HL
  • bimodal peak: 25-30 and > 55
49
Q

reed sternberg cells

A
  • seen in HL
  • express CD30 and CD15 antigens
  • have multiple nuclei
50
Q

how does HL spread

A
  • starts in single node/ chain of nodes

- spreads contiguously

51
Q

RF for HL

A
  • male predominance
  • SES and enviornment
  • EBV
  • mono
  • smoking
  • immunosuppression
  • autoimmune disease
  • family hx
52
Q

decreased risk for HL

A
  • breast feeding
  • chicken pox
  • MMR
  • pertussis
53
Q

si/sx of HL

A
  • painless LAD above diaphragm*
  • cyclic fevers*
  • night sweat
  • CP/ cough
  • pruritis
  • LN pain s/p alcohol ingestion
  • cerebellar degeneration
  • erythema nodosum
54
Q

dx of HL

A
  • LN bx and histology
  • BM bx
  • plain xrays show mediastinal mass
  • CT, PET
  • ESR for staging
  • LDH- marker of disease burden
55
Q

tx of HL

A
  • based on stage and clinical scenario

- early favorable vs. early unfavorable vs advanced

56
Q

tx for early favorable HL

A
  • 3-4 cycles of chemo

- xrt

57
Q

tx for early unfavorable HL

A
  • 4-6 cycles of chemo
58
Q

tx for advanced HL

A
  • 6-8 cycles of chemo

- xrt for bulky disease or residual activity on PET

59
Q

criteria for favorable early HL

A
  • < 2 sites
  • no extranodal invovlement
  • no mediastinal mass > 1/3 thoracic diameter
  • ESR < 50 or <30 with b sx

clin med IV (23 decks)

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