Lymphoma Cases Flashcards
What age groups does Hodgkin’s lymphoma affect most often? In which is is considered a “common” cancer?
young people (15-25ish) and old people (70s)
It’s considered common in young people just because they have so few cancers
How do you make a lymphoma diagnosis - any lymphoma diagnosis?
YOU NEED TO TAKE AN EXCISIONAL BIOPSY
and do flow cytometry on it
What’s the standard chemo regimen for HD?
ABVF: adriamycin, bleomycin, vinblastine, dacarbazine
How do we stage lymphomas?
stage 1: only one lymph node affected
stage 2: two or more lymph nodes affected on the same side of the diahragm
stage 3: two or more lymph nodes above and below the diaphragm
stage 4: widespread disease with multiple organs affected
Is HD considered a curable cancer?
yes - goal is always to cure regardless of stage
What are the most common secondary tumors after chemo for HD?
solid tumors: lung cancer and breast cancer
leukemias
Besides secondary cancers, what are some late effects of therapy for HD?
heart disease (from radiation to mediastinum)
Lung disease
impaired fertility
What chemo drug is a particular culprit for lung disease?
bleomycin
What will the immunohistochemistry markers be for HD?
sdf
If a biopsy shows effased lymph node architecture with a CD5-, CD19+, CD20+, CD23- large lymphocytes, what’s the diagnosis?
Diffuse large B cell lymphoma
How does the IPI Scoring system work for prognosis?
You get a point for the followin gparameters and the higher score you have, the worse your prognosis: age over 60 years, performance status of 2-4, stage 3-4 disease, LDH elevated, extranodal - more than 1 site
What’s the most common NHL in adults?
diffuse large B cell lymphoma
What’s the chemo regimen for DLBCL?
R-CHOP
What’s the most common INDOLENT NHL? (DLBCL is aggressive)
follicular lymphoma
Why do most follicular lymphomas present as advanced stage?
because they’re often asymptomatic until late stage
Is the goal of treatment a cure or not in follicular lymphoma
nope - not curable with chemo
What’s the genetic abnormality in follicular lymphoma?
t(14:18) - you put Bcl2 near an IgH, so you don’t have apopotsis - this is why it’s a slow growing tumor - the cells just aren’t dying
When do you initiate treatment for the indolent NHLs?
when forced to: the “pushy nodes” (causing hydronephrosis, jaundice, dysphagia, stridor), cytpoenias, B symptoms and fatigue
What’s the most aggressive of the B-cell lymphomas?
burkitt’s
Besides DLBCL, what’s the other aggressive B cell lymphoma (but not as bad as BUkitts)?
Mantle cell
If a biopsy shows CD20+ CD5+, CD23- atypical lymphocytes that stain strongly for cyclin D1, what is it”
mantle cell lymphoma
what’s the translocation in mantle cell lymphoma?
t(11:14) - you get cyclin D next to IgH
If flow cytometry shows CD19+ CD20+ (dim), CD10-, CD23+, kappa neg, lambda pos (dim), and CD5+, what do they have?
CLL
Why is the kappa negative, lambda positive super significant?
Because if the lymph node is just a reactive node, you’d have a mix of the two - that only one is positive means it’s a monoclonal expansion
How do you stage CLL?
Rai:
stage 0 - lymphocytosis with leukemia cells in blood or marro
1 - lymphocytosis with lymphadenopathy at any site
2 - lymphocytosis with organomegaly with or without lyphadeopthy
3 - disease-related anemia
4- disease-related thrombocytpenia
Do you automatically need to treat CLL?
no - there is NO survival benefit with early treatment of low risk patients
What is the most common genetic abnormality in CLL> Good or bad prognosis?
13q14.3 - favorable prognosis
If a biopsy taken during an EGD revealed nodules with lymphocytic infilatration of the stomach mucosa with the following markers: CD20+, CD10-, CD5-, CD23-, what is it?
malt lymphoma
What bacteria is associated with malt lymphoma?
h. pylori
If a patient has a solid organ transplant and put on immune suppressors, after which they develop what apears to be a lymphoma with EBV-induced poly-clonal expansion of B cells, what’s the issue?
The immune suppressors include a calcineurin inhibitor that’s blockign activagin of T cells, so you don’t get T cell inhibition on B cells so they go crazy
What targeted drug do we have for CD20?
Rituximab - works great for B cell lymphomas
