Lymphoma Therapeutics Flashcards
Where are hematologic malignancies located
blood, bone marrow, lymph nodes
how is hodgkins lymphoma (HL) characterized
Reed Sternberg Cells
what are the risk factors for HL
EBV, impaired immune function (HIV)
how does HL present
pruritus
B symptoms (fever, night sweats, unintentional weight loss)
what is the gold standard for diagnosing HL
excisional nodal biopsy
How is HL staged
early stage favorable
early stage unfavorable
advanced stage
what are the unfavorable factors for HL
-large mediastinal adenopathy
-multiple involved nodal regions
-B symptoms
-extranodal involvement
-elevated ESR rate
what is the goal with HL
cure with minimal toxicities and long term complications
how does neutropenia affect the treatment of HL patients
continue to treat despite neutropenia
how to treat early stage favorable HL
ABVD + Radiation
(Doxorubicin, Bleomycin, Vinblastine, Dacarbazine)
what are toxicities associated with doxorubicin
cardiotoxicity
what are toxicities associated with bleomycin
pulmonary toxicity
what is the treatment for early stage unfavorable HL
ABVD + radiation
what is the treatment for advanced stage HL
ABVD + radiation or
AAVD (doxorubicin, brentuximab, vinblastine, dacarbazine)
how many cycles of ABVD chemo should be used in HL
2-4 cycles in early
6-8 cycles in advanced
how to treat relapsed HL
high dose chemo followed by autologous stem cell rescue
what are risk factors for non-hodgkin lymphoma (NHL)
infections (EBV, herpes virus, h. pylori) or immunodeficiency
how to confirm diagnosis
excisional biopsy is best
describe follicular lymphoma
Indolent growing, not typically curable
when to treat follicular lymphoma
only if patient is symptomatic or patient preference
what can follicular lymphoma turn into
Via Richter’s transformation, follicular lymphoma can turn into an aggressive NHL
what should be tested in diffuse large b-cell lymphoma (DLBCL)
double/triple hit (MYC, BCL2, BCL6)
what is the treatment for stage I/II DLBCL
R-CHOP + Radiation 3 cycles
R-CHOP 6 cycles
what is the treatment for stage III/IV DLBCL
R-CHOP 6 cycles or
Pola + R + CHP 6 cycles
what is R-CHOP
rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone
what are toxicities in R-CHOP regimens
neutropenia
thrombocytopenia
what is a concern with rituximab
Hepatitis B reactivation
what must be tested prior to the start of anti-CD20 therapy
Hepatitis B Surface Antigen and Hepatitis B Core Antibody
if a patient tests positive for HepB surface antigen or core antibody what should they be started on
Entecavir
How should relapsed DLBCL/Aggressive NHL be treated
-Salvage chemo followed by autologous stem cell rescue or CAR-T
-palliative chemo
-BiTE
Describe Multiple Myeloma (MM)
abnormal clonal plasma cells infiltrating the bone marrow
secrete immunoglobulins that reek havoc
what is the presentation for multiple myeloma
CRAB
Calcium > 11.5
Renal Dysfunction Scr > 2 or CrCl < 40
Anemia < 10 or 2 less than normal
Bone: osteolytic lesions or fractures
what is the treatment goal of MM
disease control
1st time treatment needs to be the best, won’t respond as well down the road
treatment plan for MM
induction (remission) –> consolidation (transplant) –> maintenance
when treating MM what you must determine about the patient
are they a stem cell candidate>
what is the 3 drug regimen for MM
VRD (Lenalidomide, Dexamethasone, Bortezomib)
