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Boards > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

EBV

A

Burkitt Lymphoma

Hodgkin Lymphoma

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2
Q

HTLV-1

A

T cell leukemia and lymphoma

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3
Q

HCV

A

Splenic Marginal Zone Lymphoma

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4
Q

HIV

A

B-Cell Lymphomas

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5
Q

Kaposi sarcoma herpesvirus

A

Kaposi sarcoma

Primary Effusion Lymphoma

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6
Q

Sjögren Syndrome

A

Extranodal Marginal Zone Lymphomas

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7
Q

Best diagnostic tool for Lymphoma

A

Excisional Biopsy > Core Needle Biopsy

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8
Q

Basics of Ann Arbor Lymphoma Staging

A

Stage I: single lymph node region or single extralymphatic site (1E)
Stage II: more than 1 LN region on SAME side of diaphragm
Stage III: LNs on both sides of diaphragm; if Hodgkin (III1= upper abdomen, III2= lower abdomen)
Stage IV: disseminated extralymphatic Disease involving one or more organ

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9
Q

Which lymphoma types do not necessarily need a bone marrow biopsy if PET is negative?

A

Hodgkin

Large Cell Lymphoma

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10
Q

What do the lymphoma stages A and B mean?

A

B = symptoms of fevers, drenching night sweats or weight loss

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11
Q

Are non-Hodgkin Lymphomas B- or T- Cell derived?

A

85% B cell derived

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12
Q

List the Indolent B Cell Lymphomas

A

CLL
Hairy Cell Leukemia
MALT Lymphoma
Follicular

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13
Q

What is the most common indolent B cell lymphoma?

A

Follicular Lymphoma

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14
Q

Genetics of Follicular Lymphoma

A

t(14;18) leading to overexpression of BCL2 oncogene

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15
Q

How is Follicular Lymphoma Treated?

A

Minority (presenting with local disease)— radiation therapy with curative intent

Majority (asymptomatic and advanced when presenting)— rituximab + chemo—> remission in ~90% but does not increase overall survival

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16
Q

What is the dreaded complication of follicular lymphoma and how common is it?

A

30% transformation to Diffuse Large B cell Lymphoma

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17
Q

How does gastric MALT therapy differ from MALT at other sites?

A

Treat with abx+ PPI

Usually radiation therapy alone leads to a good response

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18
Q

What are the common B Cell markers?

A

C19,20,23

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19
Q

How do you diagnose CLL?

A

Smear with increased lymphocytes (smudge cells), and flow cytometry with B cell markers and coexpressuon of CD5 (t-cell marker)

** do NOT need bone marrow biopsy

20
Q

What is the term for CLL with more lymphoma manifestation?

A

Small Lymphocytic Lymphoma

21
Q

What are two important considerations for patients with CLL/Small Lymphocytic Lymphoma?

A

(1) Relative immunosuppression — May need IVIG if getting lots of infections
(2) can get autoimmune cytopenias (ex ITP, autoimmune hemolytic anemia)

22
Q

What is the dreaded complication of CLL and how common is it?

A

Richter Transformation (transformation to large cell lymphoma)- in 5% of patients

23
Q

How does hairy cell leukemia present?

A

Cytopenias and Splenomegaly

24
Q

What genetic mutation is important in hairy cell leukemia?

A

BRAFV600E

25
Q

What is the standard treatment for hairy cell leukemia?

A

Purine Nucleoside Agents (pentostatin or cladribine)

If BRAF mutation can use Vemurafenib

26
Q

List the aggressive B Cell Lymphomas

A

Diffuse Large B Cell
Mantle Cell
Burkitt

27
Q

What is the typical presentation for diffuse large B cell lymphoma?

A

Neck or abdomen enlarging adenopathy

33% with systemic symptoms

28
Q

Biopsy results in DLBCL?

A

Large atypical lymphoid cells with prominent nucleoli and basophilic cytoplasm

29
Q

What is the typical treatment for diffuse large B cell lymphoma?

A

R-CHOP (usually advanced at presentation) +- consolidators radiation

30
Q

What features are associated with a poor prognosis in diffuse large B cell lymphoma?

A

Elevated LDH, extensive tumor burden, poor performance status

31
Q

Who usually gets primary mediastinal large cell lymphoma? Which cells do these arise from?

A

Young females, arising from thymic B cells

32
Q

Who typically gets mantle cell lymphomas?

A

Men, median age 68

33
Q

What are the genetic mutations associated with mantle cell Lymphoma?

A

t(11;14) causing overexpression of cyclin D

34
Q

What is the genetic mutation associated with Burkitt lymphoma?

A

MYC gene activation

35
Q

What are the treatment considerations for Burkitt lymphoma?

A

(1) Tumor Lysis syndrome is anticipated

(2) treat for occult CNS involvement given risk for leptomeningeal involvement

36
Q

What is the typical treatment for Burkitt lymphoma?

A

Multi agent chemo with Rituximab

37
Q

What are the two types of cutaneous T-cell lymphoma?

A

Mycosis Fungoides

Sézary Syndrome

38
Q

What are the defining features of Sézary syndrome?

A

Diffuse Erythroderma

Malignant T cells circulating in blood

39
Q

What is the genetic mutation associated with anaplastic large cell lymphoma and why is it important?

A

t(2;5) = variant ALK gene translocation

Can use Crizotinib

40
Q

How is lymphoblastic lymphoma treated?

A

Like ALL (very aggressive)

41
Q

How do you diagnose Hodgkin Lymphoma?

A

Bone marrow biopsy with Reed Sternberg cells (owl eyes)

42
Q

How do you stage Hodgkin Lymphoma?

A

PET and Physical Exam

43
Q

What is the most commonly used chemo regimen in the USA for Hodgkin Lymphoma?

A 
ABVD +\- field radiation 
Doxorubicin
Bleomycin
Vinblastine
Dacarbazine
44
Q

What may you do for relapsed Hodgkin lymphoma?

A

Allogenic Hematopoietic Stem Cell Transplant

With

Brentuximab Vedotin (anti-CD30 monoclonal Ab) consolidation

45
Q

What is important to do after 2 to 3 cycles of chemotherapy in Hodgkin lymphoma?

A

PET- if negative, may not need radiation

46
Q

How does nodular lymphocyte predominant Hodgkin lymphoma differ from classic Hodgkin lymphoma?

A

10% of cases, more likely to be localized, associated with higher rate of late relapse.

Usually can treat with radiation therapy alone if early stage

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