Lymphomas Flashcards
What is NHL?
proliferation of malignant T or B cells and their precursors
What are risk factors for NHL?
1, genetics (Wiskott-Aldrich syndrome, severe combined immunodeficiency)
2. Autoimmune diseases
3. Immunosuppression (HIV/AIDs, Graft-versus-hist disease)
4. chronic pharmacologic immune suppression (solid organ transplant)
5. infection
6. radiation
7. chemicals
What infections may cause NHL?
- Epstein barr virus
- human T cell lymphotropic virus
- human herpes virus 8
- H. pylori
What chemicals may cause NHL?
- benzene
- herbicides
- insecticides
- some chemo
What are the 3 types of NHL?
- indolent
- aggressive
- highly aggressive
How does NHL present?
- should be painless
- non-contiguous pattern of spread
- possible “B” symptoms
What is the treatment for indolent NHL?
- observation
- radiotherapy
- Rituximab +/- bendamustine
What is the MOA of Rituximab?
- monoclonal antibody binds to CD20+ receptors of expressing lymphoid cells
- complement-dependent apoptosis
- macrophage-mediated killing
What are adverse effects with Rituxumab?
- infusion-related reactions (hypotension, bronchospasm, angioedema, fever, chills, rigors, pruritus, dyspnea)
- reactive latent infections (HepB, chicken pox/ shingles)
Why is indolent NHL usually incurable?
cells divide so slow chemo is not effective
What is the treatment for aggressive NHL?
- R-CHOP (standard)
- R-CVP (gentle)
- R-EPOCH (most aggressive)
What agents are in R-CHOP?
Rituximab
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone
How many cycles should R-CHOP be given?
max 8; give 2 cycles after the patient’s best response
What are adverse events with cyclophosphamide?
- myelosuppression/ mucositis
- N/V/D
- alopecia
(blind stupid chemo)
What are adverse events with Doxorubicin?
- extravasation
- cardiac toxicity
- urinary color changes
- myelosuppression
- N/V
alopecia
(bling stupid chemo)
What are adverse events with Vincristine?
- peripheral neuropathy
- extravasation
- constipation
- alopecia
What are adverse events with prednisone?
- insomnia
- increased appetite
- hyperglycemia
- psychosis
- edema
What agents are used for refractory NHL?
no anthracycline given; Rituximab + agents not used OR radioimmunotherapy
What is given in combination with high-dose chemo for highly aggressive HNL?
CNS/ cranial irradiation
What agents are used to treat highly aggressive NHL?
R-CHOP is not adequate; need more
How do HIV-associated lymphomas present?
- large B-cell and Burkett’s lymphoma
- profound B symptoms
What are treatment strategies for HIV associated lymphomas?
- low dose chemo regimens to decrease immune suppression
- concurrent antiretroviral treatment
- CNS prophylaxis/ cranial irradiation
What is the etiology of HL?
- infection (EBV)
- immunosuppression (HIV, organ transplant)
- higher socioeconomic background
What is the histology of HL?
Reed-Sternberg cells
What is the reason Reed-Sternberg cells have an “owl eyes” appearance?
cells have 2 nuclei; possible fusion of reticular cells, B cells, T cells, or both lymphocytes
How does HL present?
- lymphadenopathy (enlarged, painless lymph nodes)
- “B” symptoms
- alcohol-induced lymph node pain
- pruritis
What are “B” symptoms?
- fever >38 degrees C for unknown reason
- drenching night sweats
- unexplained weight loss (loss of 10% of body weight in 6 months before diagnosis)
How does HL progress?
- contiguous spread to adjacent lymph nodes
- more aggressive over time
- spreads to liver, bone marrow, bone
What factors cause a poorer prognosis factor for HL?
- “B” symptoms
- male
- older age
What is the goal of HL treatment?
cure in all patients
What agents are used to treat HL?
ABVD:
Doxorubicin
Bleomycin
Vinblastine
Dacarbazine
What is the treatment of early favorable stage IA and IIA HL?
ABVD (2-4 cycles) + XRT
What is the treatment for early unfavorable IB and IIB HL?
ABVD (4-6 cycles) + XRT
What is the treatment for advanced favorable IIIA and IVA HL?
ABVD (6-8 cycles)
What is the treatment for advanced unfavorable IIIB and IVB HL?
AVBD (6-8 cycles)
What is the maximum amount of cycles of AVBD a patient can get?
8 cycles due to Doxorubcin
What is the difference between favorable and unfavorable HL?
presence of B symptoms
What are side effects with Bleomycin?
- pulmonary fibrosis
- hypersensitivity
What are side effects with Vinblastine?
- peripheral neuropathy
- extravasation
- constipation
What are side effects with Dacarbazine?
- myelosuppression
- N/V
What are treatments for refractory/ relapsed HL?
- Brentuximab (antiCD30 monoclonal antibody)
- alternate chemo
- stem cell transplant
