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Lymphomas- Weir Flashcards

1
Q

The first 12 slides are from the “I’d like you to know” slide.

A

Pay attention.

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2
Q

What 4 major factors must a doctor consider when he/she decides if cure is possible for a patient with lymphoma?

A
  1. Tumor histology
  2. Tumor stage
  3. Condition of patient (co-morbidities, etc.)
  4. Available therapies
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3
Q

Name the most common indolent lymphoma.

A

Follicular lymphoma

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4
Q

Name the most common aggressive lymphoma.

A

Diffuse large cell lymphoma

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5
Q

Be able to stage a patient with lymphoma.

A
  1. Stage I: single node or lymphoid structure
  2. Stage IE: one site other than a lymph node
  3. Stage II: 2+ lymph regions on one side of diaphragm
  4. Stage III: both sides of diaphragm
  5. Stage IV: extranodal beyond E (sole site of disease)
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6
Q

What are the major treatment decision differences between indolent and aggressive lymphoma?

A

Indolent: only treat when symptomatic
Aggressive: early therapy required

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7
Q

Understand the mechanism and site of action of Rituximab.

A

Binds to B cell’s CD20 surface antigens.

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8
Q

Understand the mechanism and site of action of Ibrutinib.

A

Binds to BTK (enzyme essential for B cell development).

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9
Q

What is the name of the most common cutaneous lymphoma and what cell can you find in the blood in some of these patients?

A

Mycosis fungoides, a T cell lymphoma. If patient has Sezary Syndrome, abnormal cells are found in the peripheral blood with characteristic cerebriform, large, and clefted nuclei with fine chromatin pattern and scant cytoplasm.

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10
Q

What is a common complication of radiation therapy in young Hodgkin’s Disease women?

A

Breast cancer

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11
Q

Name 2 complications of CLL.

A
  1. Coomb’s + autoimmune hemolytic anemia

2. Infections due to hypogammaglobulinemia

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12
Q

Name 2 poor prognostic chromosome abnormalities in CLL.

A
  1. del(17p): deletion of p53 region or mutation (worst prognostic factor)
  2. Unmutated variable heavy chain (VH) genes
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13
Q

When is BM transplantation used in lymphomas?

A

Aggressive lymphomas that relapse.

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14
Q

End of “I’d like you to know” section.

A

Recognize.

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15
Q

Masses found in lymphoma can cause what?

A
  1. Lymphadenopathy
  2. Ureteral obstruction
  3. Spinal cord compression
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16
Q

Replacement of BM in lymphoma causes what?

A

Pancytopenia

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17
Q

Reduction in the number of plasma cells in lymphoma causes what?

A

Hypogammaglobulinemia

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18
Q

What 3 tumor products are produced in lymphomas?

A
  1. Uric acid
  2. Calcium
  3. Products of cell lysis
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19
Q

What paraneoplastic syndromes can be associated with lymphomas?

A
  1. Autoimmune hemolytic anemia
  2. Idiopathic thrombocytopenia purpura
  3. Neuropathy
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20
Q

What are the toxicities of therapy observed in lymphoma patients?

A

Infections, numbness, and shortness of breath.

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21
Q

What are the 4 WHO classifications of lymphomas?

A
  1. Indolent
  2. Aggressive
  3. Highly Aggressive
  4. B or T Cell
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22
Q

What are the 4 indolent lymphomas?

A
  1. Follicular
  2. CLL/small lymphocytic
  3. MALT lymphomas
  4. Mycosis fungoides
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23
Q

What are the 4 aggressive lymphomas?

A
  1. Diffuse (except small lymphocytic)
  2. Large cell
  3. Mantle cell
  4. Peripheral T cell lymphomas (NOS, angioimmunoblastic, anaplastic)
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24
Q

What are the 2 highly aggressive lymphomas?

A
  1. Burkitt’s and non-Burkitt’s small cleaved

2. T cell lymphoblastic lymphoma

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25
Q

What are the 6 lymphoma staging tests?

A
  1. History and exam
  2. CAT scan: chest, abdomen, and pelvis
  3. BM aspirate and bx w/ flow cytometry
  4. Gallium or PET scan
  5. Chemistries, CBC, LDH
  6. CSF if high risk disease
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26
Q

If a large node does not light up on PET scan, what does this mean?

A

The lymph node is not active i.e. dead, necrotic, etc.

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27
Q

Indolent lymphomas are usually found in what stages?

A

Higher stages

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28
Q

Indolent lymphomas have a high or slow progression?

A

Slow

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29
Q

T or F. Simple therapies work well for indolent lymphomas.

A

T

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30
Q

Are indolent lymphomas curable?

A

Yes, if found in Stage I or II. However, they are not curable in Stages III and IV.

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31
Q

Is it better to treat an indolent lymphoma in the early or late stages?

A

Doesn’t matter. Patient survival is independent of early treatment.

32
Q

When do you treat indolent lymphomas?

A

Only when the pt is symptomatic.

33
Q

How do aggressive lymphomas differ from indolent lymphomas?

A

Often found in lower stage. Rapid progression. Requires complex therapies. Potentially curable. Early therapy required.

34
Q

What is the most common lymphoma in the US?

A

Diffuse large cell lymphoma

35
Q

What factors in the International Prognostic Index get you a point?

A

Age >60, Stage III-IV, LDH elevated, Performance status >1, 1+ extranodal sites.

36
Q

For IPI, what are the 4 categories and their score?

A
  1. Low risk: 0-1
  2. Low intermediate risk: 2
  3. High intermediate risk: 3
  4. High risk: 4
37
Q

For the Follicular IPI, what factors get you a point?

A

Age >60, nodal sites >4, LDH elevated, Stage III-IV, Hb <12.

38
Q

What are the 7 herapies for indolent lymphomas?

A
  1. Local irradiation (indolents very sensitive to radiation)
  2. Alkylators and prednisone
  3. Anthracyclines
  4. Fludarabine
  5. Ab therapy
  6. Radiation-labeled Ab’s
  7. Combination chemotherapy
39
Q

What are the 3 alkylators used in indolent lymphoma therapy?

A
  1. Chlorambucil
  2. Cyclophosphamide
  3. Bendamustine
40
Q

What are the 2 combination chemotherapies used for indolent lymphomas?

A
  1. CHOP: cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone
  2. Fludarabine + Mitoxantrone
41
Q

What are the 5 therapies for aggressive lymphomas?

A
  1. CHOP
  2. Ab + CHOP (R-CHOP)
  3. Radio-immunotherapy
  4. Short course chemo + radiation
  5. BM transplant for relapse
42
Q

What is R-CHOP?

A

Rituximab + CHOP

43
Q

What are the 4 new emerging targeted therapies for lymphomas?

A
  1. Alemtuzumab: anti-CD52
  2. Brentuximab vedotin: anti-CD30
  3. Ibrutinib: anti-BTK
  4. Inotuzumab ozogamicin: anti-CD22
44
Q

What types of lymphomas does Alemtuzumab treat?

A

CLL and T cell leukemias resistant to therapy

45
Q

What types of lymphomas does Brentuximab vedotin treat?

A

Hodgkin’s and CD30+ T cell lymphomas

46
Q

What has Ibrutinib shown clinically?

A

Dramatic responses to refractory disease.

47
Q

What 5 infections are associated with lymphomas?

A
  1. HIV
  2. HTLV-1
  3. EBV
  4. H. Pylori
  5. HHV8
48
Q

HIV infection is associated with what?

A

Primary CNS lymphoma and Kaposi’s sarcoma.

49
Q

HTLV-1 infection is associated with what?

A

Peripheral T cell lymphoma

50
Q

EBV infection is associated with what?

A

Most commonly associated with lymphoma after transplant.

51
Q

H. Pylori infection is associated with what?

A

MALT lymphomas

52
Q

HHV8 is associated with what?

A

Kaposi’s sarcoma and pleural effusion lymphoma

53
Q

What cell type is seen in Hodgkin’s disease?

A

Reed-Sternberg cells

54
Q

What are the 4 types of Classical Hodgkin’s Disease?

A
  1. Lymphocyte rich
  2. Nodular sclerosis
  3. Mixed cellularity
  4. Lymphocyte depleted
55
Q

What 3 ways can you treat early stage Hodgkin’s?

A
  1. Short course chemo + focal radiation
  2. Radiation alone
  3. Chemo alone (moving towards this option)
56
Q

What 2 combination chemotherapies are used to treat late stage Hodgkin’s?

A
  1. ABVD (preferred)

2. MOPP

57
Q

What does ABVD consist of?

A

Adriamycin (doxorubicin/hydroxydaunorubicin), Bleomycin, Vinblastine, Dacarbazine

58
Q

What does MOPP consist of?

A

Mustargen, Oncovin (vincristine), Procarbazine, Prednisone

59
Q

Since Hodgkin’s responds so well to therapy, what is the main concern of the disease?

A

Complications/toxicities from the therapies.

60
Q

In Hodgkin’s, what are the late complications of therapy?

A

Acute leukemia and myelodysplasia. Solid tumors of breast, lung, stomach, bone, or soft tissues. CAD. Radiation and chemo pneumonitis. Infertility. Hypothyroidism.

61
Q

Why is ABVD preferred for young women with Hodgkin’s?

A

It only minimally decreases fertility in women.

62
Q

What type of malignancy is CLL?

A

Low grade B cell malignancy

63
Q

What age patients usually have CLL?

64
Q

Describe symptoms of CLL.

A

Often asymptomatic. Lymphocytosis, lymphadenopathy, splenomegaly, anemia, autoimmune cytopenias, hypogammaglobulinemia.

65
Q

Describe the Rai staging of CLL.

A

0=lymphocytosis
1=enlarged lymph nodes
2=hepatosplenomegaly
3=Hb100,000 (non-immune)

66
Q

Describe the Binet staging of CLL.

A

A=0-2 areas
B=3-5 areas
C=Hb100,000

67
Q

What stages in the Rai and Binet systems of CLL would require early treatment?

A

Rai: 3-4
Binet: C

68
Q

What are the 5 poor prognostic indicators for CLL?

A
  1. High stage
  2. Increased lymphocyte doubling time
  3. B2 microglobulin increased
  4. del(17p), TP53 mutations, del(11q)
  5. Unmutated VH genes, ZAP-70, CD38
69
Q

del(17p) results in loss of what?

70
Q

What are the 5 treatments of CLL?

A
  1. Alkylators: chlorambucil, cyclophosphamide
  2. Purine analogues: fludarabine
  3. Immunotherapy: rituximab, alemtuzumab
  4. Radiation
  5. Corticosteroids
71
Q

Hairy Cell Leukemia is what type of disorder?

A

Indolent B cell proliferative disorder

72
Q

Which gender is more likely to have HCL?

A

Male (4:1)

73
Q

What are the 3 symptoms of HCL?

A
  1. Splenomegaly
  2. Pancytopenia
  3. Decreased cell-mediated immunity
74
Q

What stain is used to show hairy cells in HCL?

A

TRAP stain (tartrate-resistant acid phosphatase)

75
Q

HCL shows very high and enduring response rates to which 2 drugs?

A
  1. 2-chlorodeoxyadenosine

2. Deoxycoformycin

76
Q

What are the 4 types of T cell lymphomas?

A
  1. Mycosis fungoides
  2. Angioimmunoblastic
  3. Anaplastic
  4. Adult T cell leukemia/lymphoma
77
Q

What are the CD markers for HCL?

A

CD19,20,22,11c,25,103

Heme (38 decks)

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