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Heme > Lymphomas > Flashcards

Lymphomas Flashcards

1
Q

diffuse large cell lymphoma - prognosis

A

intermediate grade
req aggressive chemo to get remission
cure possible w/ aggressive tx

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2
Q

describe lymphoma staging

A

stage 1 = one group of lymph nodes on one side of diaphragm
stage 2 = 2 or more sites on same side of diaphragm
stage 3 = both sides of diaphragm or splenic involvement
stage 4 = diffuse or extra lymphatic organ involvement

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3
Q

DLCBL flow cytometry

A

CD19+, CD20+

may have aberrant CD5 (normally a T cell marker)

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4
Q

DLCBL pathology on lymph node biopsy

A

large B cells (cleaved or non-cleaved)

rounded or folded vesicular chromatin and 1-3 nucleoli

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5
Q

IPI for determining DLBCL prognosis

A

lower score is better
>60yrs
LDH level
Extranodal involvement/ann arbor stage

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6
Q

how to tx DLBCL

A

stage I or II - chemo and radiation combo

stage III and IV - chemotherapy alone (radiation doesn’t work b/c too diffuse)

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7
Q

CHOP chemotherapy

A

cyclophosphamide, doxorubicin, prednisone
standard for DLCBL
+ add rituximab

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8
Q

stem cell transplant for DLBCL?

A

yes, autologous!

for relapsed DLBCL

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9
Q

lymph node morphology in follicular lymphoma

A

increased number of follicles, packed back to back with thin mantle zones

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10
Q

characteristic cells in follicular lymphoma

A

centrocytes: small cleaved cells w/ indistinct nucleoli

and centroblasts: large cells w/ round/oval nuclei and prominent, multiple nucleoli –> determines grade

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11
Q

follicular lymphoma flow cytometry

A

CD10+ - originates in follicle
CD19+, CD20+
BCL2 positive

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12
Q

follicular lymphoma genetic abnormality

A

T(14;18)(q32;31)

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13
Q

how do you treat follicular lymphoma grade III

A

like DLCBL (w/ CHOP + rituximab)

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14
Q

why is follicular lymphoma grade I and II not curable?

A

Bcl2 translocation means cells won’t die

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15
Q

FLIPI score - 5 criteria

A 
1 point for each
age >60
Hgb 4 LN sites
stage III or IV
LDH elevated
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16
Q

follicular lymphoma tx

A

initial: watch and wait
UNLESS: bulky/painful adenopathy, organ involvement, cytopenias, autoimmune cytopenias, B symptoms, high FLIPI
- if tx, stage I/IIA - radiation, stage IIB-IV gentle chemo (R-CVP)

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17
Q

R-CVP

A

chemo for high grade follicular lymphoma
rituximab, cytoxan, vincristine, prednisone
rituximab significantly prolongs remission and survival

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18
Q

transformed follicular lymphoma

A

follicular lymphoma –> DLBCL

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19
Q

marginal zone lymphoma - 3 types

A
  1. nodal marginal zone lymphoma
  2. extranodal marginal zone lymphoma/MALT
  3. splenic marginal zone lymphoma
20
Q

MALT lymphoma

A

flow cytometry: positive B cell non-specific markers
assoc w/ H. pylori infection
ulcer sx

21
Q

flow cytometry of mantle cell lymphoma

A

FMC7 positive

22
Q

mantle cell lymphoma path

A

starry sky

large mantle zone

23
Q

mantle cell immunophenotype and cytogenetics

A

CD20+, CD5+, CD23-, CD10-

t(11,14) –> overexpression of cyclin D

24
Q

cytogenetics of mantle, marginal, and follicular

A

mantle cell: t(11,14)

marginal: t(11,18)
follicular: t(14,18)

25
Q

mantle cell natural hx

A

worst characteristics of indolent and aggressive
leukemic component
3-7 yr survival w/ chemo

26
Q

mantle cell tx

A

chemo + autologous transplant - improves survival

allogenic transplant for cure

27
Q

Burkitt’s lymphoma

A

starry sky appearance

t(8:14) –> persistant expression of MYC (cell cycle on switch)

28
Q

mycosis fungoides

A

T cell lymphoma infiltrating the skin
Sezary cells, paltrier microabcesses w/ collection of T cells in the epidermis
3 stages: patch stage –> plaque stage –> tumor stage (death by staph or pseudomonas)

29
Q

Hodgkin’s lymphoma path

A

reed stenberg cells

30
Q

Hodgkin’s subtypes

A
  1. nodular sclerosis - most common subtype of hodgkin’s
  2. lymphocyte rich = good
  3. mixed cellularity = more extensive and aggressive
  4. lymphocyte poor = also more aggressive
31
Q

Hodgkin’s cell markers

A

CD15 and CD30 +

but CD45 - (to distinguish from reactive process like EBV)

32
Q

Hodgkin’s presentation

A

generalized adenopathy, mediastinal mass, systemic symptoms, hepatosplenomegaly

33
Q

Hodgkin’s tx

A

early stages - chemo ABVD and radiation

late - just radiation

34
Q

lymphoma and virus association

A

they are assoc - 25-40% of HIV pts get a malignancy

  • EBV and Burkitts
  • Hep C and NHL
35
Q

who usually gets ALL?

A

children <6

36
Q

bone marrow findings in ALL (T cell and B cell)

A

Blasts!
TdT positive
B-ALL: CD10, CD19
T-ALL: CD3, CD7

Cyogenetics: may have t(9,22) mutation - use gleevac in combo w/ chemo

37
Q

ALL tx

A

induction w/ goal of remission
- multidrug regin b/c tends to develop resistance quickly
consolidation - 6-12 months of more chemo
CNS prophylaxis
autologous BM transplant (children) or allogenic (high risk children and adults)

38
Q

where do you often see ALL metastasis?

A

CNS - do prophylaxis to prevent this

39
Q

CLL - where does it fall on the spectrum

A

low grade - similar to follicular lymphoma

- indolent, but not curable

40
Q

dx of CLL

A

lymphocytosis or adenopathy
clonal expansion of abnormal B lymphocytes
path of peripheral blood, BM, or lymph node biopsy

41
Q

path of CLL

A

mature lymphocytes w/ clumped (soccer ball) chromatin)
smudge cells
erythroid precursors

42
Q

immunophenotype of CLL

A

CD19, CD23, CD5
Monoclonal w/ kappa-lamba restriction
very low density surface Ig, CD20

43
Q

IgVh gene mutation

A

in CLL, impt for prognosis
UNMUTATED = BAD (derived from immature cells)
MUTATED = GOOD (derived from mature cells)

44
Q

deletion 17P

A

p53 mutation

worst prognosis for CLL

45
Q

deletion 13q

A

better prognosis for CLL

46
Q

when should CLL be treated?

A

based on symptoms, NOT JUST ON POOR PROGNOSTIC INDICATORS

47
Q

CLL tx

A

chemo
mAb (rituzin)
allogeneic transplant for pts who don’t respond well

Heme (16 decks)

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