Lymphoma Flashcards
Lymphoma - classification, features, diagnosis
Classification
Hodgkin lymphoma vs Non-Hodgkin lymphoma
Indolent (inc Marginal zone lymphoma, Follicular lymphoma - which you treat only if symptomatic) vs Aggressive (inc DLBCL, Burkitt lymphoma - which you treat to prevent early death complications)
Symptoms/features of lymphoma
Lymphadenopathy (nodal and extranodal inc GI, cerebral, bone, skin) –> bulky nodes and compressive symptoms
Splenomegaly
Bone marrow –> type B symptoms (fever, night sweats, unintentional weight loss); metabolic issues (hypercalcemia, gout from high urate)
Diagnosis
Biopsy of node/mass/bone marrow
High LDH, urate, hypercalcemia
Pan CT (B/neck/C/A/P)
Functional imaging (PET scan for hodgkin’s lymphoma or DLBCL)
BMAT
lumbar puncture (?CNS involvement)
Lymphoma - prognosis and treatment
Prognosis
Ann Arbor staging
Stage I: single node
stage II: >or= nodal groups on same side diaphragm
Stage III: nodal groups on both sides of the diaphragm
Stage IV: Bone marrow/extranodal involvement
Treatment
Chemotherapy
Radiotherapy
Autologous stem cell transplant +/- allogeneic stem cell transplant (e.g. mantle cell lymphoma)
Mantle cell lymphoma
Treatment: R-CHOP
Indicated for pts with previously untreated mantle cell lymphoma (stage II-IV), with intention to proceed to autologous stem cell transplant
Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Pred
- Ritux: risk adverse rxn and nausea. Reduced risk with pre-meds (steroid, panadol, loratadine). Given antiemetics (maxalon, stemitil) 1st dose IV, subsequent s/c
- cyclophosphamide: risk renal toxicity (dose reduce with severe impairment)
- Doxorubicin (anthracycline): risk cardiotoxicity. Should assess baseline w TTE/gated pool scan/ECG. Dose reduce with liver impairment. Risk of urine discolouration for 48hrs (orange)
- Vincristine: risk peripheral neuropathy, neurotoxicity
- pred: risk of hyperglycemia, gastric irritation (need PPI)
Need for G-CSF, prophylaxis (antifungal, antiviral, PJP)
