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Radiation oncology phase B > Lymphoma NHL > Flashcards

Lymphoma NHL Flashcards

1
Q

B cell NHL

A

DLBCL 33%, Follicular 20%, MALT, B cell CLL, mantle cell

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2
Q

T cell example (15%)

A

T/NK cell,
peripheral T cell lymphoma,
mycosis fungoides,
anaplastic large cell

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3
Q

low grade nhl

A

follicular grade 1-2
CLL
MALT,
mycosis fungoides

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4
Q

intermediate grade

A 
follicular grade 3
mantle cell
Dlbcl
T/NK cell
peripheral T cell lymphoma
anaplastic large cell
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5
Q

high grade

A

burkitt lymphoma

lymphoblastic lymphoma

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6
Q

international prognostic index for nhl

A 
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
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7
Q

follicular lymphoma international prognostic index

A

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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8
Q

Deuville score: international staging and response criteria for lymphoma:

A
  1. no uptake
  2. uptake mediastinum
  3. uptake>mediastinum liver
  4. uptake moderately higher than liver
  5. uptake markedly higher than liver
    X. new areas of uptake unlikely to be related to lymphoma
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9
Q

follicular lymphoma stage III, IV symptomatic treatment

A 
1st line chemo schedule:
R-chop
R-CVP(rituxi, cyclophos, vincristine, prednisone)
bendamustine+rituximab
rituxi+lenalidomide
rituxi+fludarabine
obinutuzumab
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10
Q

DLBCL: stage I/II rx

A

R CHOP 3 cycle than IFRT
or
R chop six cycle

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11
Q

DLBCL advanced stage III IV rx

A

R CHOP 6 cycle preferred

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12
Q

CT regimen NHL low grade

A 
R chop
R CVP
FC/FC r (fludarabine/cyclo rituxi)
FCM(fludarabine+cyclo+mitoxantrone)
CHVP+interferon alpha
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13
Q

NHL intermediate grade CT regimen

A 
CHOP
R CHOP
CHOP Intensified
ECHOP add etoposide
ACVBP ( doxo cyclo vindesine bleo prednisolone)
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14
Q

RCHOP schedule details

A 
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
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15
Q

salvage therapy for NHL

A 
ICE [IFOSFAMIDE, CARBO, ETO]
R-ICE 
IVE ifos eto epirubicin
MINE mesna+ifos, mitoxantrone, etoposide
ESHAP etopo, methylprednisolone, cytarabine, cisplatin
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16
Q

Risk factors for NHL

A

-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

17
Q

Aggressive NHL

A

DLBCL, mantle cell lymphoma, peripheral Tcell lymphoma, follicular lymphoma grade 1,2,, burkitt lymphoma, primary cns lymphoma

18
Q

indolent NHL

A

follicular lymphoma,
marginal zone lymphoma
mycosis fungoides

19
Q

Radiotherapy dose for early stage disease as part of combined modality treatment

A

30 gy in 15 fractions given in three weeks

20
Q

radiotherapy dose of consolidation radiotherapy in advanced stage disease

A

30-36 gy in 15-18 daily fractions given in three to three and half weeks

21
Q

consolidation radiotherapy for primary mediastinal and extranodal high grade non hodgkin lymphoma

A

30-36 gy in 15-18 daily fraction given in three to three and a half weeks

22
Q

radiation dose for low grade non hodgkin lymphoma

A

24-30 gy in 12-15 daily fraction given in twa and a half to three weeks

23
Q

radiaotherapy dose for splenic radiation

A

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

24
Q

Radiotherapy dose for palliative purpose

A

4 gy in 2 daily fractions
8 gy single
20gy in 5 fr
24 gy in 12 fr
30 gy in 10 daily fractions

25
Q

GELF criteria for initiation of treatment

A

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)

26
Q

Radiotherapy dose for cns lymphoma

A

40 gray 20 fraction
45 gray 25 fraction

27
Q

Radiotherapy dose for total skin electron therapy

A

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

28
Q

Indication of lumbar puncture: in case of high risk of CNS involvement

A

-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

29
Q

Sites of extra nodal lymphoma

A

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.

30
Q

Exposure and disease associated with NHL

A

Infectious agent
Environmental exposure
Occupational exposure
Prior chemotherapy and radiotherapy
Inherited immunodeficiency states
Acquired immunodeficiency states
Auto immune and inflammatory disorders
Family history

31
Q

Infectious agents associated with NHL

A

EBV
Human T cell lymphotropic virus (HTLV-1)
Human herpes virus 8
bacterial
Chronic hepatitis B infections
Helicobacter pyloris
Chlamydia psittaci
Campylobacter jejuni

32
Q

Csf exam required in NHL

A

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

Radiation oncology phase B (33 decks)

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