Lymphoma - Block 4 Flashcards
Types of lymphoma?
- Hodgkin’s dx
- Non-Hodgkin’s Lymphoma
RF of lymphoma?
- Epstein-Barr Virus
- Immunosuppressed patients
- Family hx
What are reed-sternberg cells?
Cells associated with HD (malignant B cells)
* Owel eye cells
Presentations of HD?
- Fatigue, malaise
- Enlarged lymph node
- B sx: unexplained fever, night sweats, weight loss
How is HD diagnosised?
- Biopsy
- Imaging
Staging used for HD?
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)
What are objective RF of HD?
- 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)
What is early-stage favorable HD?
Disease is stage I to II with no unfavorable risk factors
What is early-stage unfavorable HD?
Disease is stage I to II with unfavorable risk factors
* B symptoms,extranodal disease, bulky disease, 3+ nodes
What is advanced stage HD?
Disease is stage III to IV
Tx options for lymphoma?
- Chemotherapy
- Radiation
- Stem cell transplant
What are the primary chemo regimens?
- MOPP
- ABVD
- Stanford V
- BEACOPP
What are the components of MOPP?
- Nitrogen mustard
- Vincristine
- Procarbazine
- Prednisone
Components of ABVD?
- Doxorubicin
- Bleomycin
- Vinblastine
- Dacarbazine
What are the components of Stanford V?
- Nitrogen mustard
- Doxorubicin
- Vinblastine
- Vincristine
- Bleomycin
- Etoposide
- Prednisone
What are the components of BEACOPP?
- Bleomycin
- Etoposide
- Doxorubicin
- Cyclophosphamide
- Vincristine
- Procarbazine
- Prednisone
Downsides of using MOPP?
Sterility and malignancy from nitrogen mustard
Presentations of early stage favorable?
Stage IA and IIA:
1. No fever
1. No B-symptoms
1. No mediastinal mass
Tx for early stage favorable?
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
What is the prognosis of having early stage favorable?
> 90% for dx free progression and overall survival rate
What are the presentations of earlyy stage unfavorable?
Stage 1-2:
* Mediastinal mass
* Symptomatic (B-sx)
* Numerous sites of dx
* Elevated ESR
* Poor prognostic facotrs
Tx for early stage unfavorable?
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
Tx for advanced stage disease?
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
What is the goal for relapse tx?
Cure
Indications for relapse tx?
- Fail radiation alone; successful with MOPP or ABVD
- Fail chemo worse prognosis
I
Tx for relapse tx?
First line: Autologous stem cell txpt
Second line: Caution with anthracycline use
* Brentuximab vedotin- CD30+ antibody-conjugate
* Bendamustine
* Lenalidomide
* Everolimus
What are the long term complications of HD chemo?
- Secondary malignanices (breast, lung, GI) requiring annual x rays and mammograms
- Cardiac toxicity
- Fertility issues
- Hypothyroidism
Chemo regimen used if infertility was a concern?
ABVD
What are the RF of NHL?
- Autoimmune dx
- AIDS
- Solid organ transplant
- Infection (H. pylori, HIV, EBV)
- Chemical exposure (Organophosphates, pesticides)
- Chromosomal abnormalities
How is the common cause of NHL?
About 80-90% NHL are of B cell origin
Presentations of NHL?
- Lymphadenopathy
- B sx (less common than HD)
- Enlargement of spleen and liver
- Ab pain
How do you diagnose NHL?
Tissue biopsy
How do you stage NHL?
- Labs
- Imaging
- Ann Arbor Staging (used but less important for prognosis than in HD)
- Bone marrow biopsy
Prognosic facotrs of NHL?
- Age >60Y
- Abnormal LDH levels
- Performance status ≥2
- Ann Arbor stage 3-4
- Extranodal involvement ≥2 sites
What are the types of tx for NHL?
- Indolent (%40): supportive care
- Aggressive (60%): cure if possible, relieve symptoms, minimize toxicities
NHL are based on what facotrs?
- Age
- Specific site/type/stage
- Pt preference
- Comorbidities
Tx options for NHL?
- Radiation
- Chemo
- Monoclonal antibodies
Monoclonal Ab used for NHL? MOA?
Rituximab: Monoclonal antibody directed against CD20 antigen on B-lymphocytes
ADR of rituximab? Tx of ADR?
- 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
What are the tx approaches to indolent lymphoma?
Not curative:
Conservative: watch and wait -> treat sx
Aggressive: treat immediately
What supportive care do we need to consider for NHL?
Tumor lysis syndrome: hydration and allopurinal
