Lymphomas

Question 1

Hodgkin Lymphomas derive from which lymph cell and non derive from which cells?

Answer 1

B cell derived

Can be t, b, or NK cell derived

Question 2

What are the two age distributions of HL, which virus and infection is it associated with?

Answer 2

15-35 and 55-70

EBV and mono

Question 3

Two major categories of HL and what are the 4 histological types fo the first category?

Answer 3

Classic and nodular lymphocyte predominant (men between 30 and 50).
Nodular sclerosis, mixed cellularity, lymphocyte rich and lymphocyte depleted.

Question 4

What is the primary clinical presentation in patients with LAD? What is the second most common presentation? What symptoms can a lot of these patients suffer from?

Answer 4

Painless peripheral LAD most commonly seen in cervical and or supraclavicular LNs.

Mediastinal mass on chest x ray.

b symptoms, temp over 38, weight loss of more than 10% of body weight, and drenching night sweats.

Question 5

What is the preferred method of diagnosing and what are we looking for with HL?

Answer 5

Ecisional biopsy.

RS cells with a background of inflammatory cells and fibrosis.

Question 6

What two tests are used for the initial staging of HL and what other two tests can be used to help?

Answer 6

CT and PET are initial.

Bone marrow biopsy and aspirate

Question 7

What is state 1-4 of Ann Arbor staging system for lymphomas?

Answer 7

1. Single LN region or single extra-nodal organ or site of involvement.
2. 2 or more LN regions or lymph structures involved on same side of diaphragm
3. Involvement of LN regions on both sides of diaphragm
4. Diffuse involvement of one or more extranodal sites or tissues.

Question 8

What are 4 stage modifiers to be familiar with that can change prognosis of the staging?

Answer 8

Presence of B symptoms, absence of b symptoms, extranodal site involvement, and bulky mass (more than 10cm).

Question 9

What is the most commonly used chemotherapy regimen for HL?

Answer 9

ABVD regimen

Doxorubicin, bleomycin, vinblastine, and dacarbazine

Question 10

How would we treat a patient presenting with early stage HL?

Answer 10

2-3 month course of the regimen followed by a course of radiation to the area especially if there is a bulky mediastinal mass.

Question 11

How would we treat advanced state HL?

Answer 11

6 months of chemotherapy alone.

Question 12

What is very important concerning follow up with HL patients who are treated with chemo?

Answer 12

They are at risk for secondary malignancies due to treatment so its important that they get long term follow up with CBC and imaging.

Question 13

What is recommended prior to starting the ABVD regimen for HL?

Answer 13

Baseline cardiac and pulmonary function because of cardiac and pulmonary side effects.

Question 14

The majority of lymphomas in adults are if what cell derivation?

Answer 14

B cell

Question 15

What are some common associations with NHL even though the etiology is mostly unknown?

Answer 15

Autoimmune conditions, immunodeficiency, infections like EBV, h pylori and chlamydia and hep c.

Question 16

What are the three levels for NHL that we use to identify aggressiveness?

Answer 16

Indolent or low grade, aggressive or intermediate, and highly aggressive or high grade.

Question 17

Indolent lymphomas often present with what?

Answer 17

Slow progressing LAD and abnormal CBC like anemia, thrombocytopenia, etc.

Question 18

Aggressive lymphomas often present how?

Answer 18

Rapid LAD and mass goring with b symptoms and elevated LDH and uric acid.

Question 19

What is the preferred method of diagnosis for NHL?

Answer 19

Excisional biopsy

Question 20

All B cell derived NHLs have what two markers and what marker is found on T cell derived NHLs?

Answer 20

19 and 20

3

Question 21

What are all the lab values, studies and imaging that needs to be done before chemo treatment that will help with staging?

Answer 21

CBC, CMP, calcium, uric acid and LDH
Check HIV, hep b and c because of the association with HIV and viral hepatitis
CT scans of chest, abdomen and pelvis
Bone marrow biopsy and lumbar puncture to see if its bone and CSF

Question 22

What two things do we use in the treatment of B cell NHLs? What is the difference between prognosis of B cell lymphomas and T cell lymphomas?

Answer 22

Chemo and anti cd 20 like rituximab

T cell lymphomas have worse prognosis and more likely to relapse

Question 23

Talk about the importance of beta 2 microglobulin and its role with determining prognosis of lymphomas?

Answer 23

Beta 2 microglobulin is produced in excess amounts in lymphoproliferative malignancies and it is cleared by the kidneys. Someone with a beta 2 microglobulin greater than 5 have an adverse prognosis compared to someone with the same stage all things equal and has less than 5. Patients with impaired renal function will have elevated baseline beta 2 microglobulin levels, so need to make sure we take patients kidney function into account.