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Oncology > Lymphomas > Flashcards

Lymphomas Flashcards

1
Q

What is NHL?

A

proliferation of malignant T or B cells and their precursors

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2
Q

What are risk factors for NHL?

A

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

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3
Q

What infections may cause NHL?

A
  1. Epstein barr virus
  2. human T cell lymphotropic virus
  3. human herpes virus 8
  4. H. pylori
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4
Q

What chemicals may cause NHL?

A
  1. benzene
  2. herbicides
  3. insecticides
  4. some chemo
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5
Q

What are the 3 types of NHL?

A
  1. indolent
  2. aggressive
  3. highly aggressive
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6
Q

How does NHL present?

A
  1. should be painless
  2. non-contiguous pattern of spread
  3. possible “B” symptoms
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7
Q

What is the treatment for indolent NHL?

A
  1. observation
  2. radiotherapy
  3. Rituximab +/- bendamustine
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8
Q

What is the MOA of Rituximab?

A
  1. monoclonal antibody binds to CD20+ receptors of expressing lymphoid cells
  2. complement-dependent apoptosis
  3. macrophage-mediated killing
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9
Q

What are adverse effects with Rituxumab?

A
  1. infusion-related reactions (hypotension, bronchospasm, angioedema, fever, chills, rigors, pruritus, dyspnea)
  2. reactive latent infections (HepB, chicken pox/ shingles)
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10
Q

Why is indolent NHL usually incurable?

A

cells divide so slow chemo is not effective

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11
Q

What is the treatment for aggressive NHL?

A
  1. R-CHOP (standard)
  2. R-CVP (gentle)
  3. R-EPOCH (most aggressive)
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12
Q

What agents are in R-CHOP?

A

Rituximab
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone

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13
Q

How many cycles should R-CHOP be given?

A

max 8; give 2 cycles after the patient’s best response

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14
Q

What are adverse events with cyclophosphamide?

A
  1. myelosuppression/ mucositis
  2. N/V/D
  3. alopecia
    (blind stupid chemo)
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15
Q

What are adverse events with Doxorubicin?

A
  1. extravasation
  2. cardiac toxicity
  3. urinary color changes
  4. myelosuppression
  5. N/V
    alopecia
    (bling stupid chemo)
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16
Q

What are adverse events with Vincristine?

A
  1. peripheral neuropathy
  2. extravasation
  3. constipation
  4. alopecia
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17
Q

What are adverse events with prednisone?

A
  1. insomnia
  2. increased appetite
  3. hyperglycemia
  4. psychosis
  5. edema
18
Q

What agents are used for refractory NHL?

A

no anthracycline given; Rituximab + agents not used OR radioimmunotherapy

19
Q

What is given in combination with high-dose chemo for highly aggressive HNL?

A

CNS/ cranial irradiation

20
Q

What agents are used to treat highly aggressive NHL?

A

R-CHOP is not adequate; need more

21
Q

How do HIV-associated lymphomas present?

A
  1. large B-cell and Burkett’s lymphoma
  2. profound B symptoms
22
Q

What are treatment strategies for HIV associated lymphomas?

A
  1. low dose chemo regimens to decrease immune suppression
  2. concurrent antiretroviral treatment
  3. CNS prophylaxis/ cranial irradiation
23
Q

What is the etiology of HL?

A
  1. infection (EBV)
  2. immunosuppression (HIV, organ transplant)
  3. higher socioeconomic background
24
Q

What is the histology of HL?

A

Reed-Sternberg cells

25
Q

What is the reason Reed-Sternberg cells have an “owl eyes” appearance?

A

cells have 2 nuclei; possible fusion of reticular cells, B cells, T cells, or both lymphocytes

26
Q

How does HL present?

A
  1. lymphadenopathy (enlarged, painless lymph nodes)
  2. “B” symptoms
  3. alcohol-induced lymph node pain
  4. pruritis
27
Q

What are “B” symptoms?

A
  1. fever >38 degrees C for unknown reason
  2. drenching night sweats
  3. unexplained weight loss (loss of 10% of body weight in 6 months before diagnosis)
28
Q

How does HL progress?

A
  1. contiguous spread to adjacent lymph nodes
  2. more aggressive over time
  3. spreads to liver, bone marrow, bone
29
Q

What factors cause a poorer prognosis factor for HL?

A
    • “B” symptoms
  2. male
  3. older age
30
Q

What is the goal of HL treatment?

A

cure in all patients

31
Q

What agents are used to treat HL?

A

ABVD:
Doxorubicin
Bleomycin
Vinblastine
Dacarbazine

32
Q

What is the treatment of early favorable stage IA and IIA HL?

A

ABVD (2-4 cycles) + XRT

33
Q

What is the treatment for early unfavorable IB and IIB HL?

A

ABVD (4-6 cycles) + XRT

34
Q

What is the treatment for advanced favorable IIIA and IVA HL?

A

ABVD (6-8 cycles)

35
Q

What is the treatment for advanced unfavorable IIIB and IVB HL?

A

AVBD (6-8 cycles)

36
Q

What is the maximum amount of cycles of AVBD a patient can get?

A

8 cycles due to Doxorubcin

37
Q

What is the difference between favorable and unfavorable HL?

A

presence of B symptoms

38
Q

What are side effects with Bleomycin?

A
  1. pulmonary fibrosis
  2. hypersensitivity
39
Q

What are side effects with Vinblastine?

A
  1. peripheral neuropathy
  2. extravasation
  3. constipation
40
Q

What are side effects with Dacarbazine?

A
  1. myelosuppression
  2. N/V
41
Q

What are treatments for refractory/ relapsed HL?

A
  1. Brentuximab (antiCD30 monoclonal antibody)
  2. alternate chemo
  3. stem cell transplant

Oncology (22 decks)

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