Lymphoma Flashcards
t(14;18)
t(11;18)
t(11;14)
t(8;14)
t(14;18) follicular
t(11;18) marginal
t(11;14) mantle
t(18;14) burkitts
1st line treatment follicular lymphoma
stage 1 or 2: RT or observation
stage 3a: if indications to treat - ritux monotherapy or benda + ritux
stage 3b: benda + ritux = RCHOP. rev/ritux can also be considered if not candidate for chemoimmno
but if high grade (>15 centromeres) – R-CHOP
GC versus ABC
Double hit lymphoma
GC type - arise from normal germinal center B cells
ABC type - arise from post-germinal center B cells that are arrested during plasmacytic differentiation
Not so good px with R-CHOP
MYC — 5-15% and worse px
BCL2 — 1/3 DLBCL
BCL6 — 1/3 DLBCL
If both - “double hit” now called high grade lymphoma with rearrangements in MYC and - - MYC gene together with rearrangement of BCL2 and/or BCL6
R-EPOCH in DLBCL
Use for high risk groups — HIV (dose different), double hit, PMBCL (primarily mediastinal mass, typically 20-30 yo, avoid mediastinal RT), looking like Burkett type picture
Neuro ppx in DLBCL
Neuro PPX IF
Testis, breast, nasal sinus, orbits, BM, kidney, adrenal
High risk CNS IPI, double hit lymphoma, HIV
CAR-T in in DLBCL
relapsed to 2 lines of systemic therapy
Yescarta (Axicabtagene)
Kymirah (Tisagenlecleucel)
CLL diagnosis
(1) peripheral blood monoclonal B-lymph count 5000 or more
(2) CD5+/CD23+
(3) % of prolymphocytes <55% of lymphocytes
SLL
clonal b cell population within LN, liver, spleen but the pt doesn’t have peripheral monoclonal b lymph count of 5000 or more
CLL poor risk factors
17p
11q
CLL good risk factors
13q
mutated igVH
ZAP negative
Flow for hodgkin lymphoma
CD15+/CD30+
Exception - non-classical nodular lymphocytic predominant HL sub-type is CD20+ and CD15 and CD 30 negative
Deuville Scoring
1 = no uptake 2 = uptake < liver 3 = uptake similar to liver 4 = uptake moderately > liver 5 = uptake markedly > liver
lymphoma staging
stage 1 = 1 LN
stage 2 = 2+ LN same side diaphragm
stage 3 = 2+ LN both sides diaphragm
stage 4 = extra-nodal organ
A/B = b sx
X = bulky dx; mediastinal mass > 1/3 diameter thorax or mass > 10cm
Treatment HL Stage I-IIA
Favorable:
ABVD x 2 –> restaging PET –> 20 Gy RT
Unfavorable:
ABVD x 2 –> restaging PET –> 2 more cycles ABVD + 30 Gy RT
Treatment HL Stage III-IV
ABVD x 2 –> restaging PET –> 4 more cycles ABVD + RT if bulky disease
Relapsed/Refractory HL
Brentuximab based therapy (+/- PD1 agent) Traditional chemotherapy (ICE, DHAP) then PET/CT --> if PET negative --> auto tx and brentuximab maintenance for those eligible
Start brentuximab maintenance – pts who have 2 or more risk factors obtain most benefit:
primary refractory HL, PR or SD as best response before transplant, 2 or more prior salvage therapies, extranodal disease at relapse, B sx after failure of frontline therapy
Brentuximab
Ab portion of the drug attaches to CD30 on the surface of malignant cells, delivering MMAE (antimitotic agent monomethyl auristatin E) which is responsible for the anti-tumor activity
Unfavorable disease in hodgkin lymphoma
Unfavorable = Bulky, B Symptoms, 3+ LNs
Siltuximab for castleman’s
ab directed against IL-6
DLBCL treatment
Limited Stage: RCHOP 3 cycles + RT or 4-6 cycles PET-guided treatment
Advanced Stage: R-CHOP x 6 cycles
CLL/SLL versus mantle lymphoma on flow
CLL/SLL and mantle lymphoma are CD5+ but normally CLL/SLL is CD23+ and CD20 dim and mantle is usually CD23- and more strongly expresses CD20.
Cyclin d usually + mantle cell; t(11;14)
Angioimmunoblastic T cell lymphoma
CD4+, rash, EBV, fluid retention, coombs+ hemolysis
Tx: CHOP based therapy followed by auto transplant
Double hit DLBCL
mutations in MYC + BCL2 +/- BCL6
Differentiating DLBCL and burkitt’s
Both CD10+, CD20+
t(8;14) seen
how to treat advanced stage follicular lymphoma - low grade
observation ritux monotherapy r or o + CHOP r or o + bendamustine r or o + lenalidomide r or o + cvp
how to treat advanced stage follicular lymphoma - high grade
treat like DLBCL - r-chop
