Lymphoma Cases & Review - Kebbekus Flashcards
1
Q
What is important to examine when thinking about a lymphoma diagnosis?
A
- Physical exam
- check all lymph node chains
- B symptoms
- Weight loss (>10%)
- Drenching night sweats
- Fever (don’t make sense)
- CBC with differential
- Metabolic panel
- LDH
- HIV testing
- Uric acid (purines from killed cells)
- prevent kidney disease
-
Excisional biopsy
- If cancer is the issue, tissue is the answer
- Bone marrow
- Flow cytometry
- Staging imaging (CT/PET)
2
Q
What characterizes Hodgkin’s Lymphoma?
A
- Malignant cell = Reed-Sternberg cell
- Now recognized as a B-cell origin
- some are CD20+
- Bulk of the tumor is reactive tissue
- Spreads contiguously from node to node
3
Q
What are the symptoms of Hodgkins’ Lymphoma?
A
- Enlarging, rubbery, but not tender lymphadenopathy
- typically in neck or chest
- Accompanied by:
- fatigue
- feverB
- weight lossB
- night sweatsB
- Pain with EtOH
- Symptoms of cytopenias
- Hepatosplenomegaly
4
Q
How common is Hodgkin’s Lymphoma?
A
- Rare cancer
- Common in young people with cancer
- 1 in 5 types of cancer for young people
- <4 people in 100,000 overall
- Slight male predominance (5:4 men:women)
- HIV related malignancy
5
Q
What is the best chemotherapy treatment for Hodgkin’s Lymphoma?
A
- ABVD
- Adriamycin (cardiotoxicity)
- Bleomycin (lung toxicity)
- Vinblastine (numbess)
- Dacarbazine
6
Q
What are the stages of Lymphomas?
A
- Ann Arbor Staging
- I: single lymph node region
- II: One side of diaphragm
- III: Both sides of diaphragm
- IV: Disseminated
- effusions
- liver & spleen
- bone marrow
7
Q
How is localized favorable risk HL disease treated with the intent to cure?
A
- ABVD x2 (restage)
- Involved field radiation
8
Q
How is Stage III/IV HL Disease treated?
A
- ABVD
- BEACOPP
- Autologous transplant
9
Q
What are the late effects of chemotherapy in HL?
A
- Second malignancy
- Heart disease (MI, CAD)
- Lung disease
- Impaired fertility
10
Q
What markers do you look for in Lymphoma?
A
- CD5-
- CD19+
- CD20+
- CD23-
11
Q
What sytem do you use to classify Non-Hodgkin’s Lymphoma?
A
- IPI Scoring System
- score 0-5
- 0-1 = cure
- 2 = cure most
- 3-5 = cure about half
- Prognostic factor:
- Age over 60
- Stage III/IV
- ECOG PS 3 or 4 (more than ½ day resting)
- level of physical health
- Elevated LDH
- Two or more extranodal sites
12
Q
What characterizes Diffuse Large B-cell Lymphoma?
Treatment?
A
- Prototype aggressive NHL
- Accounts for 40% of lymphomas
- Average age of onset is 67
- 75.3% of cases are above the age of 55
- If left untreated it is quickly fatal
- Treated with CHOP (more intense regimens have not been shown to improve overall survival, 1993)
- The addition of rituximab (anti-CD20) in 1997 was a difference maker: R-CHOP
13
Q
What translocation is associated with Follicular Lymphoma?
A
t(14;18)
- Bcl-2 is translocated to chromosome 14
- comes under control of IgH enhancer which leads to overexpression of BCL-2
14
Q
Is follicular lymphoma cureable?
A
- Typically (over 80%!) advanced stage at presentation
- Often asymptomatic
- FL not curable with chemotherapy
- Most common indolent NHL
15
Q
What is the survival rate in Follicular Lymphoma?
A
- Stage I-II
- 50% long term (10-20 yrs) disease free survival with radiotherapy alone (?cure?)
- Stage III-IV
- Remission rate
- 70-85% with chemo
- 50-70% with rituximab
- 70-90% with chemo + rituximab
- Cure rate 0%
- Median survival 10-12 years, longer in younger pts
