NHL Flashcards

Question 1

Q

Definition of NHL

Answer

A

NHL are diverse group of lymphocyte malignancies, often presents as lymphadenopathy. Also commonly develop in extranodal locations. Lymphomas can arise from B-cells and T-cells.

Question 2

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Lymphocyte Antigens

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NHL are B and T cell malignancies; mostly B cell disorders

Question 3

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Major subtypes of NHL

Question 4

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Lifetime risk of transformation of an indolent NHL

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The lifetime risk of transformation of an indolent non-Hodgkin lymphoma to an aggressive B-cell non-Hodgkin lymphoma is approximately 30%; the transformation rate is approximately 2% per year but varies somewhat by tumor type.

Question 5

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Staging system for Lymphomas

Question 6

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Deauville Criteria

Question 7

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Follicular Lymphoma : Characteristics

Answer

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BCL2 is overexpressed in > 85% of patients, generally as a result of a t(14;18)(q32;q21) chromosome translocation, most ptswith follicular lymphoma have an indolent course.

Question 8

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Diagnostic work up:

Answer

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Physical Examination: peripheral LN, liver, spleen
Lab: Blood count, LDH, uric acid, Electrophoresis, Beta-2 microglobulin,
Hepatitis B, C, HIV serology (risk of viral reactivation with Retuximab)
Imaging with CT or PET
Bone marrow histology, cytology, immunophenotyping

Question 9

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Main clinical tool for risk stratification at diagnosis of follicular lymphoma

Answer

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Follicular Lymphoma International Prognostic Index (FLIPI)

Question 10

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FLIPI

Answer

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FLIPI stratifies patients into three groups with differing 5-year OS rates:
(1) low-risk (0-1risk factor; OS, 91%),
(2) intermediate risk (2 risk factors; OS, 78%), and
(3) high risk (3-5 risk factors; OS, 53%).

Question 11

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Grading of Follicular Lymphomas per ESMO 2020

Question 12

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The decision to initiate therapy for follicular lymphoma requires identifying symptomatic patients or those with high tumor
burden, or risk of organ compromise. Criteria used in clinical trials by the Groupe d’Etude des Lymphomes Folliculaires (GELF)
can be useful in identifying such patients and include the following:

Answer

A

-Involvement of > 3 nodal sites > 3 cm
-Any nodal or extranodal tumor mass > 7 cm
-Systemic B symptoms
-Splenomegaly
-Cytopenias or leukemic blood involvement
-Impending organ dysfunction resulting from compression
-Pleural effusions or malignant ascites

Question 13

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Treatment of localized Follicular Lymphoma (Stages I-II)

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If limited low tumour burden stages I-II,
ISRT, 24-30 Gy is the preferred approach with a curative intent, whereas the 2 × 2 Gy schedule is less durably effective but might be used in special situations to minimise side-effects.

Combination of RT with rituximab chemotherapy (ChT) improved PFS compared with RT alone.
In selected cases (e.g. limited life expectancy, large abdominal fields), watch-and-wait or rituximab monotherapy may be considered.

In stage I-II patients with a high tumour burden, adverse clinical prognostic features or in cases where ISRT is not feasible, systemic therapy as indicated for advanced stages should be applied.

Question 14

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Evidence for Treatment of FL I-II

Question 15

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Evidence for Treatment of FL I-II : 2 x 2Gy

Question 16

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Systemic Therapy after IFRT in early stage follicular lymphoma TROG 99.03

Question 17

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Treatment of advanced Follicular Lymphoma (ESMO 2020)

Answer

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In the majority of patients with advanced stage III and IV disease, no curative therapy is yet established. Because the natural course of the disease is characterised by spontaneous regressions in 10%-20% of cases and varies significantly from case to case, therapy should be initiated only upon the development of symptoms, including B symptoms (unexplained fever >38°C, drenching night sweats or loss of >10% body weight within 6 months), hematopoietic impairment, bulky disease, vital organ compression, ascites, pleural effusion or rapid lymphoma progression.