Non-Hodgkin Lymphoma Flashcards
what infections are associated with the development of NHL?
EBV
human t-cell lymphotropic virus
H. pylori
hep C
the most common chromosomal translocations involve what genes?
c-MYC oncogen
BCL-1,2,6
NHL involves what lymphocytes?
B or T
what are the 3 classifications NHL is based on?
- cell of origin (B or T cell)
- clinical features
- morphologic features
what often involves nodes often painless, rubbery, and discrete and usually located in the cervical and supraclavicular regions as in Hodgkin lymphoma
NHL
what are referred to as B symptoms?
fever
weight loss
night sweats
what symptoms do most patients have?
B symptoms
diagnosis has to be established by pathologic assessment of tissue obtained by?
biopsy
what is the preferred type of biopsy of NHL?
excisional biopsy (entire involved lymph node is removed)
what is the gold standard for assessment of almost all lymphoma histology types
PET-CT
which stage of the ann arbor classification involves single lymph node region or structure (I) or of a single extralymphatic organ or site (IE )
stage I
which stage of the ann arbor classification involves two or more lymph node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site and of one or more lymph node regions on the same side of the diaphragm (IIE )
stage II
which stage of the ann arbor classification involves lymph node regions on both sides of the diaphragm (III), which may also be accompanied by localized involvement of an extralymphatic organ or site (IIIE ) or by involvement of the spleen (IIIS) or both (IIISE)
stage III
which stage of the ann arbor classification involves Diffuse or disseminated involvement of one or more extralymphatic organs or tissues with or without associated lymph node enlargement
stage IV
A -
B -
X -
E -
S -
CS -
PS -
A - no symptoms
B - fever, night sweats, weight loss
X - bulky disease
E - extralymphatic tissue on one side of diaphragm
S - spleen
CS - clinicial stage
PS - pathologic stage
Risk Factors According to the International Non-Hodgkin Lymphoma Prognostic Factors Project
For all patients include what 5 things?
age>60
abnormal LDH
performance ≥2
ann arbor stage III or IV
extranodal involvement ≥2 sites
Risk Factors According to the International Non-Hodgkin Lymphoma Prognostic Factors Project
For all patients ≤60 include what 3 things?
abnormal LDH
performance ≥2
ann arbor stage III or IV
what is referred to as indolent lymphomas?
slow-growth
what are the most active agents used in the treatment of NHL?
alkylating agents
bleomycin
doxorubicin
purine analogs
etoposide
methotrexate
vincristine
corticosteroids
what are lymphomas that are about 20%-25% of all new cases of NHLs and are generally indolent?
follicular lymphomas
World Health Organization (WHO) classification includes criteria for grading follicular lymphoma based on?
of centroblasts per high-power field
what is the standard treatment for follicular lymphomas localized disease stages I and II?
standard treatment is radiation therapy
chemotherapy not usually given, may be helpful in high-risk stage II disease(e.g. multiple sites of involvement or bulky disease)
what is the chemotherapy treatment for follicular lymphomas advanced disease stages II bulky, III, and IV?
R-CHOP or
BR
what is referred to as R-CHOP?
rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone
what is referred to ass BR?
bendamustine plus rituximab
what is the radioimmunotherapy treatment for follicular lymphomas advanced disease stages II bulky, III, and IV?
Y-Ibritumomab tiuxetan
what is an anti-CD20 radioummunoconjugate for indolent NHLs?
Y-Ibritumomab tiuxetan
what are the phosphatidylinositol-3-kinase (PI3K) inhibitors?
Idelalisib
Copanlisib
Duvelisib
Umbralisib
what is the first-generation EXH2 inhibitor for the treatment of follicular lymphomas advanced disease stages II bulky, III, and IV?
tazemetostat
what is the chimeric antigen receptor (CAR) T-cell therapie for the treatment of follicular lymphomas advanced disease stages II bulky, III, and IV?
axicabtagene ciloeucel
what is the most common lymphoma of all NHLs?
diffuse large b-cell lymphoma
what is the treatment for diffuse large b-cell lymphoma localized disease stages I and II?
R-CHOP
radiation therapy
what is the treatment for diffuse large b-cell lymphoma advanced disease stages II bulky, III, and IV?
R-CHOP or
rituximab and CHOP like chemo
what is the less common NHL where most patients have advanced disease at time of diagnosis?
mantle cell lymphoma (MCL)
what is the most common MCL case?
t(11:14)
what is the widely used aggressive combination regimen for MCL?
cyclophosphamide, vincristine, doxorubicin, dexamethasone alternating with methotrexate and cytarabine (hyperCVAD) with or without rituximab
what do we give for relapsed disease of MCL?
R-CHOP, bortezomib, rituximab, cyclophosphamide, doxorubicin, and prednisone (VR-CAP), bendamustine Considered if not previously given
Bortezomib with or without rituximab
Bruton tyrosine kinase (BTK) inhibitors
what are the Bruton tyrosine kinase (BTK) inhibitors?
Ibrutinib
Acalabrutinib
Zanubrutinib
Which of the following is true regarding Follicular lymphomas?
a) Follicular lymphomas are more indolent and treatment of localized disease generally includes radiation therapy, but chemotherapy can be helpful in high-risk stage II
b) Follicular lymphomas are more aggressive, treatment of localized disease generally includes chemotherapy and radiation therapy is never used as a part of treatment for localized disease
c) Follicular lymphomas are more aggressive, and treatment of localized disease only includes radiation therapy
d) Follicular lymphomas are more indolent, and treatment of localized disease generally includes targeted therapies and radiation, and chemotherapy are never utilized for the treatment for localized disease
A
Non-Hodgkin lymphomas are neoplasms derived from which of the following?
a) Monoclonal proliferation of malignant B lymphocytes and their precursors
b) Monoclonal proliferation of malignant T lymphocytes and their precursors
c) Monoclonal proliferation of malignant B or T lymphocytes and their precursors
d) Monoclonal proliferation of non-malignant red blood cells and their precursors
C
Which of the following are Phosphatidylinositol-3-Kinase (PI3K) Inhibitors?
a) Imatinib, Copanlisib, Duvelisib, Umbralisib
b) Idelalisib, Copanlisib, Duvelisib, Umbralisib
c) Idelalisib, Copanlisib, Dasatinib, Umbralisib
d) Nivolumab, Copanlisib, Docetaxel, Umbralisib
B
