Lymphoma

Question 1

t(14;18)
t(11;18)
t(11;14)
t(8;14)

Answer 1

t(14;18) follicular
t(11;18) marginal
t(11;14) mantle
t(18;14) burkitts

Question 2

1st line treatment follicular lymphoma

Answer 2

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

Question 3

GC versus ABC

Double hit lymphoma

Answer 3

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

Question 4

R-EPOCH in DLBCL

Answer 4

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

Question 5

Neuro ppx in DLBCL

Answer 5

Neuro PPX IF
Testis, breast, nasal sinus, orbits, BM, kidney, adrenal
High risk CNS IPI, double hit lymphoma, HIV

Question 6

CAR-T in in DLBCL

Answer 6

relapsed to 2 lines of systemic therapy
Yescarta (Axicabtagene)
Kymirah (Tisagenlecleucel)

Question 7

CLL diagnosis

Answer 7

(1) peripheral blood monoclonal B-lymph count 5000 or more
(2) CD5+/CD23+
(3) % of prolymphocytes <55% of lymphocytes

Question 8

SLL

Answer 8

clonal b cell population within LN, liver, spleen but the pt doesn’t have peripheral monoclonal b lymph count of 5000 or more

Question 9

CLL poor risk factors

Answer 9

17p

11q

Question 10

CLL good risk factors

Answer 10

13q
mutated igVH
ZAP negative

Question 11

Flow for hodgkin lymphoma

Answer 11

CD15+/CD30+

Exception - non-classical nodular lymphocytic predominant HL sub-type is CD20+ and CD15 and CD 30 negative

Question 12

Deuville Scoring

Answer 12

1 = no uptake
2 = uptake < liver
3 = uptake similar to liver
4 = uptake moderately > liver
5 = uptake markedly > liver

Question 13

lymphoma staging

Answer 13

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

Question 14

Treatment HL Stage I-IIA

Answer 14

Favorable:
ABVD x 2 –> restaging PET –> 20 Gy RT

Unfavorable:
ABVD x 2 –> restaging PET –> 2 more cycles ABVD + 30 Gy RT

Question 15

Treatment HL Stage III-IV

Answer 15

ABVD x 2 –> restaging PET –> 4 more cycles ABVD + RT if bulky disease

Question 16

Relapsed/Refractory HL

Answer 16

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

Question 17

Brentuximab

Answer 17

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

Question 18

Unfavorable disease in hodgkin lymphoma

Answer 18

Unfavorable = Bulky, B Symptoms, 3+ LNs

Question 19

Siltuximab for castleman’s

Answer 19

ab directed against IL-6

Question 20

DLBCL treatment

Answer 20

Limited Stage: RCHOP 3 cycles + RT or 4-6 cycles PET-guided treatment

Advanced Stage: R-CHOP x 6 cycles

Question 21

CLL/SLL versus mantle lymphoma on flow

Answer 21

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)

Question 22

Angioimmunoblastic T cell lymphoma

Answer 22

CD4+, rash, EBV, fluid retention, coombs+ hemolysis

Tx: CHOP based therapy followed by auto transplant

Question 23

Double hit DLBCL

Answer 23

mutations in MYC + BCL2 +/- BCL6

Question 24

Differentiating DLBCL and burkitt’s

Answer 24

Both CD10+, CD20+

t(8;14) seen

Question 25

how to treat advanced stage follicular lymphoma - low grade

Answer 25

observation
ritux monotherapy
r or o + CHOP 
r or o + bendamustine
r or o + lenalidomide
r or o + cvp

Question 26

how to treat advanced stage follicular lymphoma - high grade

Answer 26

treat like DLBCL - r-chop