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Oncology Exam 2 > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

Lymphoma pathophysiology

A

heterogenous group of malignancies that arise from malignant transformation of immune cells that reside in lymphoid tissue

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2
Q

How do lymphomas commonly present?

A

as solid tumor

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3
Q

How is lymphoma classified?

A

Hodgkin’s (HL)

Non-Hodgkin’s (NHL)

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4
Q

Are there more new estimated cases of HL or NHL?

A

NHL

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5
Q

Are there more estimated deaths of HL or NHL?

A

NHL

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6
Q

T/F the prognosis for HL is not good

A

False!

It is good!

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7
Q

How is HL classified?

A

4 prognostic groups

Early favorable/unfav

Advanced favorable/unfav

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8
Q

Is HL more common in males or females?

What is the age of incidence?

A

males

Bimodal: 3rd decade of life; after 50

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9
Q

HL is commonly linked with what disease?

A

EBV

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10
Q

Etiology of HL

A

Infectious

Immunosuppressed patients at higher risk

Genetics: twins 100x increase risk

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11
Q

Reed-Sternberg cells are with what cancer?

A

HL

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12
Q

HL patient presentation

A

Lymphadenopathy

Mediastinal mass

“B” symptoms (fever, weight loss, night sweats)

Hepatosplenomegaly

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13
Q

Lymph nodes in HL

A

Most commonly cervical and supraclavicular

Painless, rubbery

Pain after alcohol consumption

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14
Q

Diagnosis of HL

A

Physical exam

LDH

PET scan

Lymph node biopsy

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15
Q

What is the Ann Arbor Staging System for?

A

Lymphomas

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16
Q

Stage I Ann Arbor

A

1 lymph node area involved

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17
Q

Stage II Ann Arbor

A

2 or more lymph node areas involved on same side of diaphragm

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18
Q

Stage III Ann Arbor

A

Lymph node invovlement on both sides of diaphragm

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19
Q

Stage IV Ann Arbor

A

Extranodal involvement (bone marrow, liver, spleet etc)

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20
Q

Predicting prognosis of HL

A

>65 yo lower cure rate

Limited disease (stage I or II): higher cure rate

Advanced disease (II or IV): lower cure rate

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21
Q

What is IPS used for?

A

Advanced HL

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22
Q

Goal of HL

A

maximize cure!

minimize short and long term tx complications

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23
Q

Treatment options of HL

A

Surgery: limited role

Chemo: backbone

Radiation: some role

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24
Q

Involved field radiation

A

Single field that contains HL

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25
Q

Extended field radiation

A

Radiation to involved field + 2nd uninvolved area

AKA sub-total nodal

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26
Q

Total nodal radiation

A

radiation of all areas

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27
Q

What are the 2 frontline therapies for HL?

A

ABVD

B-AVD

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28
Q

When is Brentuximab vedotin indicated?

A

New diagnosis stage III-IV HL

**Given in combo!

Refractory CHL, refractory anaplastic large cell lymphoma

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29
Q

What is brentuximab CI with?

A

bleomycin!

Risk of pulmonary toxicity

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30
Q

Specific ADE of brentuximab

A

- Peripheral neuropathy: cause of discontinuation

- Neutropenia

- severe infections

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31
Q

For early favorable disease IA or IIA in HL what are your treatment options?

A

2-4 cycles ABVD

Involved field radiation

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32
Q

For early unfavorable disease in HL what are your treatment options?

A

Combo therapy

4-6 cycles of ABVD (or Stanford)

Involved field radiation

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33
Q

MOPP, Stanford V, ABVD, BEACOPP

Which has the least amount of toxicities and most commonly used?

A

ABVD

34
Q

What are the common ADEs of MOPP that ABVD does not have?

A

sterility

secondary leukemia

peripheral neuropathy

35
Q

What are the Stanford V and BEACOPP main toxicities?

A

Both: myelosuppression, FN

BEACOPP: sterility, secondary leukemia

36
Q

For Advanced staged unfavorable disease in HL what are your main treatment options?

A

6-8 cycles ABVD

B-AVD

BEACOPP

Stanford V

37
Q

What drugs are in ABVD?

What is different in B-AVD?

A

Doxorubicin

Bleomycin

Vinblatine

Dacarbazine

Brentuximab instead of bleomycin

38
Q

Relapsed HL treatment

A

More chemo

if remission <12 months: autologous HSCT

39
Q

PD1 inhibitors role in HL

A

for relapse or refractory disease they are an option

40
Q

Which PD1-inhibitors are used in HL?

A

Nivolumab

Pembrolizumab

41
Q

What are the most common secondary malignancies caused by HL treatment?

A

breast and lung cancer

42
Q

What are some main ADEs of HL treatment?

A

Sterility

Secondary malignancies

CV effects

Hypothyroidism

Pulmonary toxicity

43
Q

Is NHL more common in males or females?

What is the average age of diagnosis?

A

Males

67 yo

can occur at any age

44
Q

What infections are associated with etiology of NHL?

A

EBV

Human T cell lymphotropic virus type I

HSV 8: Kaposi)

45
Q

Etiology of NHL

A

Genetic: congenital and acquired immunodef

Environmental: herbicides

Infections

46
Q

Pathophysiology of NHL

A

Monoclonal proliferation of B or T lymphocytes

*most are B cell lymphomas

47
Q

How is NHL classified?

A

it keeps changing!

Most recent WHO classification (it is complicated)

48
Q

Presentation of NHL

A

Peripheral lymphadenopathy

Rapid and progressive disease

Waxing and waning

Fatigue, malaise, pruritis

B- symptoms

49
Q

Lymph nodes in NHL

A

painless, rubbery, discrete

Non-contiguous spread

50
Q

Diagnosis of NHL

A

Biopsy

Physical exam

LDH

PET/CT scan

51
Q

T/F Ann arbor staging has poor correlation between stage and prognosis for NHL

A

True

52
Q

NHL goals

A

Cure

alleviate symptoms

minimzie toxicities

53
Q

Treatment choices for NHL

A

radiation

chemo

biologics

54
Q

What is IPI used for?

A

DLBCL

55
Q

T/F DLBCL is curable and most common type of NHL

A

true!

56
Q

What is 1st line for DLBCL?

A

R-CHOP

R-EPOCH

57
Q

What is in R-CHOP?

A

Rituximab

Cyclophosphamide

Doxorubicin

Vincristine

Prednisone

58
Q

What is in R-EPOCH?

A

Etoposide

Prednisone

Vincristine

Cyclophosphamide

Doxorubicin

59
Q

What is R-CHOP used for?

A

DLBCL NHL

60
Q

Boxed warnings of rituximab

A

infusion related reactions

hep B reactivation

severe mucutaneous reactions

PML
Watch for TLS

61
Q

Benefits of R-CHOP vs CHOP

A

Ritux: increased outcomes significantly

Durable responses

Effective

Can use in elderly

Acceptable toxicity

Patient friendly

62
Q

DLBCL variants

A

MYC rearrangement

BCL2 or BCL6 rearrangement

63
Q

T/F in DLBCL double hit variants you should use R-CHOP

A

False!

Resistant to R-CHOP

Use DA-EPOCH-R

64
Q

How is DA-EPOCH-R dose adjusted?

A

based on how the 1st cycles went

based on ANC

65
Q

T/F CART can be used in HL

A

False

Used in relapsed DLBC NHL

66
Q

CART cells in DLBC

A

Target CD19

Avoid tumor evasion of immune system

Median time to response ~1 month

67
Q

When can you use CART in NHL?

A

relapsed DLBCL

Must have failed 2 prior therapies

68
Q

Management of CRS

A

Supportive care

Tocilizumab

High dose steroids: if life threatening

69
Q

Main toxicities of CART

A

CRS

Neurologic toxicities

70
Q

How do you treat neurologic toxicities associated with CART?

A

Dexamethasone

Keppra: seizure prophylaxis

Toclizumab: not as effective

71
Q

Is FL more common in males or females?

What is the median age of diagnosis?

A

females

60 yo

72
Q

Presentation of FL

A

Waxing and waning

Primarily lymph nodes, spleen, marrow

Indolent

73
Q

T/F FL is curable

A

False

typically NOT curable

74
Q

What is FLIPI used for?

A

Follicular lymphoma

75
Q

Treatment of stage I/II FL

A

if local: radiation

can observe

76
Q

Treatment of stage II bulky/III/IV FL

A

chemo only if causing symptoms

77
Q

Who should get upfront treatment in FL?

A

No convincing data of improved survival

Watch and wait for asymptomatic patients

If symptomatic: may consider therapy

78
Q

Rituximab role in FL

A

2nd line therapy

79
Q

P13K inhibitors role in lymphomas

A

2nd line to treat FL if refractory to rituximab

80
Q

Treat FL if refractory to rituximab

A

P13K inhibitors

81
Q

Main treatment for FL

A

BR or R-CHOP

Oncology Exam 2 (5 decks)

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