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847 > Lymphomas > Flashcards

Lymphomas Flashcards

1
Q

Lymphomas

A
  • Group of hematological malignancies that develop from lymphoid tissues
  • 2 Subtypes: Non-Hodgkin and Hodgkin’s Lymphoma
  • NHL: B or T cell derived
  • HL: Reed-Sternberg cells
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2
Q

NHL Clinical Presentation

A
  • Variety of symptoms depends on site of involvement
  • Fever, night sweats, weight loss (B symptoms), fatigue, malaise, pruritis
  • 2/3 of patients present with peripheral adenopathy
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3
Q

NHL Labs/Diagnostic

A

Labs

  • CBC
  • Serum electrolytes (SCr and LFTs)
  • LDH may be helpful for prognosis/response to therapy

Diagnosis

  • Biopsy
  • PET/CT scan
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4
Q

NHL Staging

A
  • Stage I: Single nodal region
  • Stage II: Two or more nodal region on same side of diaphragm
  • Stage III: Nodal regions on both sides of diaphragm
  • Stage IV: Diffuse extra-nodal disease
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5
Q

FLIP-2

A

Follicular Lymphoma International Prognostic Index

  • Age > 60
  • B-2 microglobulin > ULN
  • Hemoglobin < 12
  • Bone marrow + for disease
  • Largest lymph node > 6 cm
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6
Q

IPI

A

International Prognostic Index for NHL

  • Age > 60
  • ECOG performance status > 2
  • Serum LDH > 1x ULN
  • > 1 extranodal site of disease
  • Stage III or IV
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7
Q

Follicular Lymphoma

A
  • Indolent lymphoma in older adults
  • Most patient have advanced disease at diagnosis
  • Initial dramatic response to therapy, many relapses
  • High conversion rate to DLBCL
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8
Q

DLBCL

A
  • Diffuse Large B Cell Lymphoma
  • Most common lymphoma (30% of NHLs)
  • Treated by Stage I/II non-bulky, Stage I/II bulky, and Stage III/IV
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9
Q

DLBCL Treatment

A
  • R-CHOP
  • Given every 21 days
  • Number of cycles and inclusion of radiotherapy depends on stage/bulkiness
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10
Q

R-CHOP Toxicities

A
  • Rituximab: infusion related rxns, Hep B reactivation
  • Cyclophosphamide: myelosuppression. hemorrhagic cystitis, N/V, secondary malignancies
  • Doxorubicin: cardiac toxicity, myelosuppression, mucositis
  • Vincristine: constipation, peripheral neuropathy, jaw pain
  • Prednisone: hyperglycemia, hypertension, weight gain, insomnia
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11
Q

Relapsed/Refractory DLBCL

A
  • 10-20% don’t get complete remission, and 20-30% of those who do relapse
  • Give second line chemo with intent to get to high dose chemo and autologous stem cell transplant
  • High dose chemo with autologous HSCT is preferred in young patient with chemosensitive relapse
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12
Q

HL

A
  • Hodgkin Lymphoma
  • Malignant transformation of lymphocytes
  • Presence of Reed-Sternberg Cells
  • R-S Cells express CD30 and CD15
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13
Q

HL Etiology

A
  • Infectious exposure is a potential cause but no firm cause is known
  • Increased risk of HL if infected with EBV
  • Immunosuppressed also more likely to develop HL
  • 25x greater in HIV patients
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14
Q

HL Work-Up

A
  • Labs
  • Physical exam
  • PET/CT (Staging)
  • Bone marrow biopsy (disease extent)
  • ECHO: doxorubicin cardiotoxicity
  • Pulmonary function test: bleomycin
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15
Q

Classifications of HL

A
  1. Classical HL (CHL)

2. Nodular Lymphocyte Predominant HL (NLPHL)

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16
Q

CHL

A
  • Nodular Sclerosis
  • Mixed cellularity
  • Lymphocyte-rich
  • Lymphocyte-depleted
17
Q

Ann Arbor Staging for HL

A
  1. Early stage favorable: Stages I/II with no factors
  2. Early stage unfavorable with non-bulky disease: Stages I/II
  3. Early stage unfavorable with bulky disease: Stages I/II
  4. Advanced stage disease: Stages III/IV
18
Q

Unfavorable HL Factors

A
  • ESR > 50
  • B symptoms
  • Mediastinal mass ratio > 0.33
  • > 3 nodal sites of involvement
  • Bulky disease (any node > 10 cm)
19
Q

HL Treatment

A
  • Radiation Alone: early stage predominant
  • Chemo/Radiation
  • Salvage Chemo: choose by response to initial therapy
  • Hematopoietic stem cell transplantation
20
Q

BPT

A
  • Bleomycin pulmonary toxicity
  • Supportive care issue of ABVD
  • Need baseline pulmonary fxn tests and follow-up through treatment
  • More common with older age, pulmonary irradiation, and total doses > 400 units
21
Q

ABVD + Neutropenia

A
  • Supportive care issue of ABVD
  • Not an indication for dose reduction
  • Can give safely without growth factors
  • Bleomycin toxicities can also be exacerbated with the use of growth factors
22
Q

Extravasation Treatments

A
  • Anthracyclines: cold and dexrazoxane

- Vinca alkaloids: heat and hyaluronidase

23
Q

HL Relapse/Refractory

A
  • Majority occurs within 3 years of completing therapy
  • Second line chemo with intent to initiate high dose chemo followed by autologous HSCT
  • Radiotherapy to non previously treated sites
24
Q

Brentuximab

A
  • Anti-CD30 antibody that binds to R-S cells and releases anti-microtubule agent once inside (MMAE)
  • Use in advanced, untreated HL, relapsed/refractory HL, failure after autologous HSCT, or maintenance therapy after autologous HSCT for 1 year if high risk for relapse
  • AE: myelosuppression, peripheral neuropathy
25
Q

Nivolumab HL Indications

A
  • Progressed after autologous HSCT and brentuximab

- After 3 or more lines of systemic therapy that includes autologous HSCT

26
Q

Pembrolizumab HL Indications

A

-Relapses or refractory disease in those with 3 or more lines of chemo

27
Q

HL Survivorship

A
  • Increased risk of developing many therapy related complications
  • Detect early through screenings

Screen for following

  • Secondary cancers (lung and breast)
  • CV disease: mediastinal XRT and anthracyclines
  • Hypothyroidism
  • Fertility issues

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