Lymphomas- Weir Flashcards
The first 12 slides are from the “I’d like you to know” slide.
Pay attention.
What 4 major factors must a doctor consider when he/she decides if cure is possible for a patient with lymphoma?
- Tumor histology
- Tumor stage
- Condition of patient (co-morbidities, etc.)
- Available therapies
Name the most common indolent lymphoma.
Follicular lymphoma
Name the most common aggressive lymphoma.
Diffuse large cell lymphoma
Be able to stage a patient with lymphoma.
- Stage I: single node or lymphoid structure
- Stage IE: one site other than a lymph node
- Stage II: 2+ lymph regions on one side of diaphragm
- Stage III: both sides of diaphragm
- Stage IV: extranodal beyond E (sole site of disease)
What are the major treatment decision differences between indolent and aggressive lymphoma?
Indolent: only treat when symptomatic
Aggressive: early therapy required
Understand the mechanism and site of action of Rituximab.
Binds to B cell’s CD20 surface antigens.
Understand the mechanism and site of action of Ibrutinib.
Binds to BTK (enzyme essential for B cell development).
What is the name of the most common cutaneous lymphoma and what cell can you find in the blood in some of these patients?
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.
What is a common complication of radiation therapy in young Hodgkin’s Disease women?
Breast cancer
Name 2 complications of CLL.
- Coomb’s + autoimmune hemolytic anemia
2. Infections due to hypogammaglobulinemia
Name 2 poor prognostic chromosome abnormalities in CLL.
- del(17p): deletion of p53 region or mutation (worst prognostic factor)
- Unmutated variable heavy chain (VH) genes
When is BM transplantation used in lymphomas?
Aggressive lymphomas that relapse.
End of “I’d like you to know” section.
Recognize.
Masses found in lymphoma can cause what?
- Lymphadenopathy
- Ureteral obstruction
- Spinal cord compression
Replacement of BM in lymphoma causes what?
Pancytopenia
Reduction in the number of plasma cells in lymphoma causes what?
Hypogammaglobulinemia
What 3 tumor products are produced in lymphomas?
- Uric acid
- Calcium
- Products of cell lysis
What paraneoplastic syndromes can be associated with lymphomas?
- Autoimmune hemolytic anemia
- Idiopathic thrombocytopenia purpura
- Neuropathy
What are the toxicities of therapy observed in lymphoma patients?
Infections, numbness, and shortness of breath.
What are the 4 WHO classifications of lymphomas?
- Indolent
- Aggressive
- Highly Aggressive
- B or T Cell
What are the 4 indolent lymphomas?
- Follicular
- CLL/small lymphocytic
- MALT lymphomas
- Mycosis fungoides
What are the 4 aggressive lymphomas?
- Diffuse (except small lymphocytic)
- Large cell
- Mantle cell
- Peripheral T cell lymphomas (NOS, angioimmunoblastic, anaplastic)
What are the 2 highly aggressive lymphomas?
- Burkitt’s and non-Burkitt’s small cleaved
2. T cell lymphoblastic lymphoma
What are the 6 lymphoma staging tests?
- History and exam
- CAT scan: chest, abdomen, and pelvis
- BM aspirate and bx w/ flow cytometry
- Gallium or PET scan
- Chemistries, CBC, LDH
- CSF if high risk disease
If a large node does not light up on PET scan, what does this mean?
The lymph node is not active i.e. dead, necrotic, etc.
Indolent lymphomas are usually found in what stages?
Higher stages
Indolent lymphomas have a high or slow progression?
Slow
T or F. Simple therapies work well for indolent lymphomas.
T
Are indolent lymphomas curable?
Yes, if found in Stage I or II. However, they are not curable in Stages III and IV.