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Therapeutics IV > Lymphoma - Block 4 > Flashcards

Lymphoma - Block 4 Flashcards

1
Q

Types of lymphoma?

A
  1. Hodgkin’s dx
  2. Non-Hodgkin’s Lymphoma
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2
Q

RF of lymphoma?

A
  1. Epstein-Barr Virus
  2. Immunosuppressed patients
  3. Family hx
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3
Q

What are reed-sternberg cells?

A

Cells associated with HD (malignant B cells)
* Owel eye cells

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4
Q

Presentations of HD?

A
  1. Fatigue, malaise
  2. Enlarged lymph node
  3. B sx: unexplained fever, night sweats, weight loss
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5
Q

How is HD diagnosised?

A
  1. Biopsy
  2. Imaging
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6
Q

Staging used for HD?

A

Ann Arbor
Stage 1: single node or site
Stage 2: Two or more lymph node or sites on same side of diaphragm
Stage 3: lymph node involvement on both sides of diaphragm
Stage 4: diffuse or disseminated involvement of organs/tissues
A: no fever (asymptomatic)
B: B-sx
X: bulky dx (nodal mass >10 cm)

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7
Q

What are objective RF of HD?

A
  • Serum albumin (< 4 g/dL)
  • Hemoglobin (< 10.5 g/dL)
  • Male
  • Stage IV disease
  • Age (> 45 yo)
  • Leukocytosis (WBC >15,000/mm3)
  • Lymphocytopenia (< 600/mm3)
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8
Q

What is early-stage favorable HD?

A

Disease is stage I to II with no unfavorable risk factors

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9
Q

What is early-stage unfavorable HD?

A

Disease is stage I to II with unfavorable risk factors
* B symptoms,extranodal disease, bulky disease, 3+ nodes

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10
Q

What is advanced stage HD?

A

Disease is stage III to IV

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11
Q

Tx options for lymphoma?

A
  1. Chemotherapy
  2. Radiation
  3. Stem cell transplant
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12
Q

What are the primary chemo regimens?

A
  1. MOPP
  2. ABVD
  3. Stanford V
  4. BEACOPP
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13
Q

What are the components of MOPP?

A
  1. Nitrogen mustard
  2. Vincristine
  3. Procarbazine
  4. Prednisone
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14
Q

Components of ABVD?

A
  1. Doxorubicin
  2. Bleomycin
  3. Vinblastine
  4. Dacarbazine
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15
Q

What are the components of Stanford V?

A
  1. Nitrogen mustard
  2. Doxorubicin
  3. Vinblastine
  4. Vincristine
  5. Bleomycin
  6. Etoposide
  7. Prednisone
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16
Q

What are the components of BEACOPP?

A
  1. Bleomycin
  2. Etoposide
  3. Doxorubicin
  4. Cyclophosphamide
  5. Vincristine
  6. Procarbazine
  7. Prednisone
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17
Q

Downsides of using MOPP?

A

Sterility and malignancy from nitrogen mustard

18
Q

Presentations of early stage favorable?

A

Stage IA and IIA:
1. No fever
1. No B-symptoms
1. No mediastinal mass

19
Q

Tx for early stage favorable?

A

Combination Chemotherapy +/- Radiation Therapy:
1. ABVD or Stanford V
2. Usually 4 cycles of ABVD or 2 cycles (8 weeks) Stanford V
3. Restage after chemo and then after radiation

20
Q

What is the prognosis of having early stage favorable?

A

> 90% for dx free progression and overall survival rate

21
Q

What are the presentations of earlyy stage unfavorable?

A

Stage 1-2:
* Mediastinal mass
* Symptomatic (B-sx)
* Numerous sites of dx
* Elevated ESR
* Poor prognostic facotrs

22
Q

Tx for early stage unfavorable?

A

Combination Chemotherapy followed by Radiation Therapy:
* ABVD or Stanford V (BEACOPP also possible)
* Usually 4 cycles of ABVD or 3 cycles (12 weeks) Stanford V
* Restage after chemo and then after radiation

23
Q

Tx for advanced stage disease?

A

Stage 3-4:

Combination Chemotherapy is treatment of choice:
* ABVD or Stanford V
* BEACOPP for high-risk pt (IPS > 4)
* Radiation may be used to minimize bulky disease

24
Q

What is the goal for relapse tx?

A

Cure

25
Q

Indications for relapse tx?

A
  • Fail radiation alone; successful with MOPP or ABVD
  • Fail chemo worse prognosis
26
Q

I

Tx for relapse tx?

A

First line: Autologous stem cell txpt
Second line: Caution with anthracycline use
* Brentuximab vedotin- CD30+ antibody-conjugate
* Bendamustine
* Lenalidomide
* Everolimus

27
Q

What are the long term complications of HD chemo?

A
  1. Secondary malignanices (breast, lung, GI) requiring annual x rays and mammograms
  2. Cardiac toxicity
  3. Fertility issues
  4. Hypothyroidism
28
Q

Chemo regimen used if infertility was a concern?

A

ABVD

29
Q

What are the RF of NHL?

A
  1. Autoimmune dx
  2. AIDS
  3. Solid organ transplant
  4. Infection (H. pylori, HIV, EBV)
  5. Chemical exposure (Organophosphates, pesticides)
  6. Chromosomal abnormalities
30
Q

How is the common cause of NHL?

A

About 80-90% NHL are of B cell origin

31
Q

Presentations of NHL?

A
  1. Lymphadenopathy
  2. B sx (less common than HD)
  3. Enlargement of spleen and liver
  4. Ab pain
32
Q

How do you diagnose NHL?

A

Tissue biopsy

33
Q

How do you stage NHL?

A
  1. Labs
  2. Imaging
  3. Ann Arbor Staging (used but less important for prognosis than in HD)
  4. Bone marrow biopsy
34
Q

Prognosic facotrs of NHL?

A
  1. Age >60Y
  2. Abnormal LDH levels
  3. Performance status ≥2
  4. Ann Arbor stage 3-4
  5. Extranodal involvement ≥2 sites
35
Q

What are the types of tx for NHL?

A
  1. Indolent (%40): supportive care
  2. Aggressive (60%): cure if possible, relieve symptoms, minimize toxicities
36
Q

NHL are based on what facotrs?

A
  1. Age
  2. Specific site/type/stage
  3. Pt preference
  4. Comorbidities
37
Q

Tx options for NHL?

A
  1. Radiation
  2. Chemo
  3. Monoclonal antibodies
38
Q

Monoclonal Ab used for NHL? MOA?

A

Rituximab: Monoclonal antibody directed against CD20 antigen on B-lymphocytes

39
Q

ADR of rituximab? Tx of ADR?

A
  • Infusion reactions: pre-medicate with acetaminophen 650 mg and diphenhydramine 50 mg, 30 mins prior to infusion
  • Step up infusion
  • HepB testing prior,can reactivate HepB
  • If HepB reactivated, treat with appropriate antivirals
  • Do not use in patients with active infections
40
Q

What are the tx approaches to indolent lymphoma?

A

Not curative:
Conservative: watch and wait -> treat sx
Aggressive: treat immediately

41
Q

What supportive care do we need to consider for NHL?

A

Tumor lysis syndrome: hydration and allopurinal

Therapeutics IV (39 decks)

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