Lymphoma NHL Flashcards
B cell NHL
DLBCL 33%, Follicular 20%, MALT, B cell CLL, mantle cell
T cell example (15%)
T/NK cell,
peripheral T cell lymphoma,
mycosis fungoides,
anaplastic large cell
low grade nhl
follicular grade 1-2
CLL
MALT,
mycosis fungoides
intermediate grade
follicular grade 3 mantle cell Dlbcl T/NK cell peripheral T cell lymphoma anaplastic large cell
high grade
burkitt lymphoma
lymphoblastic lymphoma
international prognostic index for nhl
age >60 elevated LDH level stage III or IV disease ECOG PS>/2 two or more extranodal site each factor 1 point low risk 0-1 low int risk 2 high int risk 3 high risk 4-5 points
follicular lymphoma international prognostic index
HASSL: hb, age, site,stage,LDH
age >60years
ann arbor stage III-IV
elevated LDH
Hb level <12g/dl
>/5 nodal sites of disease
each factor 1 point
low risk 0-1
intermediate risk 2 point
high risk >3 point
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Deuville score: international staging and response criteria for lymphoma:
- no uptake
- uptake mediastinum
- uptake>mediastinum liver
- uptake moderately higher than liver
- uptake markedly higher than liver
X. new areas of uptake unlikely to be related to lymphoma
follicular lymphoma stage III, IV symptomatic treatment
1st line chemo schedule: R-chop R-CVP(rituxi, cyclophos, vincristine, prednisone) bendamustine+rituximab rituxi+lenalidomide rituxi+fludarabine obinutuzumab
DLBCL: stage I/II rx
R CHOP 3 cycle than IFRT
or
R chop six cycle
DLBCL advanced stage III IV rx
R CHOP 6 cycle preferred
CT regimen NHL low grade
R chop R CVP FC/FC r (fludarabine/cyclo rituxi) FCM(fludarabine+cyclo+mitoxantrone) CHVP+interferon alpha
NHL intermediate grade CT regimen
CHOP R CHOP CHOP Intensified ECHOP add etoposide ACVBP ( doxo cyclo vindesine bleo prednisolone)
RCHOP schedule details
rituximab 375 mg/m2 d1 cyclophosphamide 750 mg/m2 d1 doxorubicin 50mg/m2 d1 vincristine 1.4 mg/m2 max 2 mg D1-5 prednisolone 100 mg/m2 po low grade or 100 mg PO intermediate grade D1-5
salvage therapy for NHL
ICE [IFOSFAMIDE, CARBO, ETO] R-ICE IVE ifos eto epirubicin MINE mesna+ifos, mitoxantrone, etoposide ESHAP etopo, methylprednisolone, cytarabine, cisplatin
Risk factors for NHL
-congenital immunodeficiency syndrome
immunosuppression
AIDS
autoimmune disorder: sjogren, rheumatoid arthritis, SLE
celiac disease
exposure to ioniziing radiation
infection: H pylori, EBV, HTLV-1, Chlamydia psittacci
acquired chromosomal defect: Bcl2, Cyclin D1, MYC gene
Aggressive NHL
DLBCL, mantle cell lymphoma, peripheral Tcell lymphoma, follicular lymphoma grade 1,2,, burkitt lymphoma, primary cns lymphoma
indolent NHL
follicular lymphoma,
marginal zone lymphoma
mycosis fungoides
Radiotherapy dose for early stage disease as part of combined modality treatment
30 gy in 15 fractions given in three weeks
radiotherapy dose of consolidation radiotherapy in advanced stage disease
30-36 gy in 15-18 daily fractions given in three to three and half weeks
consolidation radiotherapy for primary mediastinal and extranodal high grade non hodgkin lymphoma
30-36 gy in 15-18 daily fraction given in three to three and a half weeks
radiation dose for low grade non hodgkin lymphoma
24-30 gy in 12-15 daily fraction given in twa and a half to three weeks
radiaotherapy dose for splenic radiation
localized low grade splenic lymphoma
24 gy in 12 daily fractions
palliative splenic irradiation
4-10 gy in fractions of 0.5-1 gy given upto three times per week
Radiotherapy dose for palliative purpose
4 gy in 2 daily fractions
8 gy single
20gy in 5 fr
24 gy in 12 fr
30 gy in 10 daily fractions
GELF criteria for initiation of treatment
Involvement of ≥3 nodal sites, each with a diameter of ≥3 cm
• Any nodal or extranodal tumor mass with a diameter of ≥7 cm
• B symptoms
• Splenomegaly
• Pleural effusions or peritoneal ascites
• Cytopenias (leukocytes <1.0 x 109/L and/or platelets <100 x 109/L) • Leukemia (>5.0 x 109/L malignant cells)
Radiotherapy dose for cns lymphoma
40 gray 20 fraction
45 gray 25 fraction
Radiotherapy dose for total skin electron therapy
Patch and plaque 8 gy in 2 fraction
Tumor 12 gy in 3 fraction
Mucoasal disease 20 gy in 10 daily fraction
Lymph node 30 gy in 15 daily fraction
Total skin electron therapy:
high dose 30 gy in 20 fraction
Low dose 12 gy in 8 fraction
Indication of lumbar puncture: in case of high risk of CNS involvement
-Diffuse aggressive NHL with bone marrow, epidural, testicular, paranasal sinus, or nasopharyngeal involvement, or two or more extranodal sites of disease
High-grade lymphoblastic lymphoma
High-grade small noncleaved cell lymphomas (eg, Burkitt and non-Burkitt types)
HIV-related lymphoma
Primary CNS lymphoma
Neurologic signs and symptoms
Sites of extra nodal lymphoma
Extranodal or extralymphatic sites include
the adrenal glands,
blood, bone.
bone marrow,
cen tral nervous system (CNS; leptomeningeal and parenchy mal brain disease),
gastrointestinal (GI) tract,
gonads,
kidneys,
liver,
lungs,
skin,
ocular adnexae (conjunctiva, lac rimal glands, and orbital soft tissue), skin,
uterus, and oth- ers.
Exposure and disease associated with NHL
Infectious agent
Environmental exposure
Occupational exposure
Prior chemotherapy and radiotherapy
Inherited immunodeficiency states
Acquired immunodeficiency states
Auto immune and inflammatory disorders
Family history
Infectious agents associated with NHL
EBV
Human T cell lymphotropic virus (HTLV-1)
Human herpes virus 8
bacterial
Chronic hepatitis B infections
Helicobacter pyloris
Chlamydia psittaci
Campylobacter jejuni
Csf exam required in NHL
May need if there is neurologic signs or symptoms or a form of NHL. May
also require in NHL involving the paranasal sinuses, testes, epidural space,
and highly aggressive histologies like Burkitt’s lymphoma
