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Emma Heme/Onc > NHL, HL > Flashcards

NHL, HL Flashcards

1
Q

mature lymphoid malignancies

A

NHL
HL
Chronic Lymphocytic Leukemia
Multiple Myeloma

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2
Q

typically lymphomas don’t circulate in blood in significant numbers except

A

CLL

SLL

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3
Q

NHL

  • cell of origin
  • age
  • lymphnodes
  • BM
  • tx (y/n)
A
  • B cell (T/NK)
  • 60-70 y/o
  • any nodes
  • often BM
  • tx: yes
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4
Q

HL

  • cell of origin
  • age
  • lymphnodes
  • BM
  • tx (y/n)
A
  • B cell
  • bimodal
  • sequential
  • often BM
  • tx: yes
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5
Q

Chronic Lymphocytic Leukemia

  • cell of origin
  • age
  • lymphnodes
  • BM
  • tx (y/n)
A
  • B cell
  • 60s-70s
  • any nodes
  • BM
  • tx: yes
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6
Q

Multiple Myeloma

  • cell of origin
  • age
  • lymphnodes
  • BM
  • tx (y/n)
A
  • B cell
  • 60s-70s
  • Rarely nodes
  • BM
  • tx: yes
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7
Q

NHL epidemiology

A
  • 5th leading cancer dx
  • most comm hematological cancer
  • 85% cells=B cell origin
  • incidence more than doubled since 70s
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8
Q

NHL

presentation

A 
local
-swollen nodes
-pain (compression/infiltration)
-organ failure/compromise 
systemic
-fevers, night sweats, weight loss, fatigue
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9
Q

indolent NHL

A
  • follicular*
  • marginal zone
  • SLL
  • lymphoplasmacytic lymphoma
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10
Q

aggressive NHL

A
  • diffuse large B-cell*
  • mantle cell
  • peripheral t-cell lymphoma
  • primary mediastinal large B-cell lymphoma
  • anaplastic large cell lymphoma
  • lymphoblastic lymphoma
  • Burkitt’s
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11
Q

T cell surface antigens

A

CD2
CD3
CD4
CD8

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12
Q

B cell surface antigens

A

CD19
CD20
CD22
CD79a

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13
Q

NHL staging

A

I-single lymph node
II-2+ nodes, same side of diaphragm
III- 2+ nodes, different sides of diaphragm
IV- extra nodal disease (BM)

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14
Q

international prognostic index (for Non-Hodgkin’s lymphoma)

A

1 pt for each risk factor:

age
performance status
LDH 
extranodal sites
Stage
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15
Q

NHL that initially responds to chemo, but ultimately recurs (not cured)

A

indolent

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16
Q

NHL with potentially profound response to chemo, ultimately curable

A

aggressive

17
Q

NHL tx

A
  • surgery has NO significant role
  • radiation
  • chemo
18
Q

classes of chemo generally used in NHL

A

alkylators
anthracylines
steroids

19
Q

indolent NHL tx

A

QOL tx

rituximab

20
Q

rituximab

A

monoclonal CD20 Ab

antibody-dependent cellular cytotoxicity (ADCC)

complement-dependent cytotoxicity (CDC)

apoptosis

21
Q

NHL chemo combo

A

CHOP

cyclophosphamide
doxorubicin
vincristine
prednisone

22
Q

HIV-associated lymphoma

A

vast majority=aggressive

  • B cell origin
  • CD4 <200
  • high viral load/advanced disease
  • tx w/ HAART –> dec risk
23
Q

HL

A

unusual variant of B-cell lymphoma (~15%)

adenopathy (progressive)

  • neck/mediatinum
  • sx: night sweats/fevers/weight loss, “pel-ebstein” fevers, pruritus, EtOH
  • typically slow, orderly growth
  • tx outcomes for early stage disease = excellent
24
Q

HL age distribution

A

bimodal, 20s or 60s

25
Q

nivolumab

A

targets PD-1 on T-cells (a suppressor of immune function)

binds and INactivates this

unleashes T cells that recognize Reed-Sternberg cells

HL tx

26
Q

half of HL cases contain ____ DNA in Reed-Sternberg cells

A

EBV

27
Q

reed sterberg cellClas

A

multinucleate giant cells derived from malignant B lymphocytes

CD30, CD15

IgH rearrangement

monoclonal

seen in classical HL (from mature B cells at germinal center)

28
Q

CD30, CD15

A

Reed Sternberg cell

29
Q

HL staging

A

I-single lymphoid chain
II-2 chains on one side of diaphragm
III-above and below diaphragm
IV-diffuse non-lymphoid spread

also

A-absense of constitutional sx
B-presence of (F/NS/>10%weight loss)
M-bulky mediastinal mass
E-involvement of extra nodal site

30
Q

classical HL

A

4 subtypes

  • nodular sclerosis
  • mixed cellularity
  • lymphocyte rich
  • lymphocyte poor
31
Q

non-classic HL

A

1 subtypes

32
Q

HL tx goals

A

aimed at cute, start ASAP

33
Q

HL

standard chemotherapy

A

ABVD

adriamycin
bleomycin
vinblastin
dacarbizine

34
Q

HL early stage tx

A

radiation alone

chemo +radiation just to site of involvement

or chemo alone

35
Q

surveillance of HL survivors

A
  • mammograms starting at 30 or 8-10 yrs from XRT

- colonoscopy 8-10 yrs post XRT

36
Q

Brentuximab

A

fusion chemo-immunoconjugate combining a monoclonal Ab against CD30 and an MT inhibitor

*RS cells =CD30

Emma Heme/Onc (16 decks)

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