Non-Hodgkin Lymphoma: DLBCL Flashcards
What is DLBCL?
Diffuse Large B-Cell Lymphoma
All B-Cell Lymphomas are _______.
CD20+
All patients with non-Hodgkin lymphoma should be assessed for?
CNS disease
What are the prognostic factors?
Age
–> 40-60 = 1
–> 60-75 = 2
>75 = 3
LDH
–> 1-3 = 1
–> >3 = 2
Ann Arbor Stage III-IV
Extranodal Disease (BM,CNS, Liver/GI Lung)
Performance 2+
What are the risk factors for CNS metastasis in Lymphoma? What are the different risk groups?
Age >60
Serum LDH > normal
Performance >1
Stage III or IV
Extranodal >1 site
Kidney or Adrenal Involvment
Low: 0-1
Intermediate: 2-3
High Risk: 4-6 or Kidney or Adrenal Gland
What are the CNS Prophylaxis Options?
–> Systemic Methotrexate (3-3.5 g/m^2) for 2-4 cycles.
—> Not ideal, Very toxic
–> IT methotrexate and/or cytarabine for 4-8 weeks
What are the indications for CNS prophylaxis?
–> Testicular Lymphoma
—> Primary Cutaneous DLBCL, Leg Type
—> Stage IE DLBC of the breast
—-> Kidney or Adrenal Gland Involvement
What is the dose of methotrexate for CNS prophylaxis in DLBCL?
Methotrexate 12 mg IT x 4 doses
What is the treatment dose of methotrexate in CNS malignancy with DLBCL? What else is given?
- Methotrexate 15 mg IT
- Hydrocortisone 50 mg IT
- Cytarabine 50 mg IT
*Twice weekly until cleared x2, then two more doses, then weekly x 4 doses.
Then with each cycle.
What is the first-line therapy for stage I-II DLBCL?
- R-CHOP
- Pola-R-CHP
What is the first line therapy for Stage II with extensive mesenteric disease or Stage III-IV?
- R-CHOP
- Pola-R-CHP
- Dose-Adjusted R-EPOCH.
What is the first line therapy for patients with poor LVEF?
- Dose-adjusted R-EPOCH
- R-CDOP
- R-CEOP
- R-GCVP
- R-CEPP
What is the first line therapy for patients who are very frail and/or >80 yo with comorbidities?
- R-mini CHOP
- R-CDOP
- R-GCVP
- R-CEPP
How many cycles do most patients receive of first-line therapy? When should they get a PET scan to assess response?
- Most patients will receive 6 total cycles of therapy, with a PET scan to assess response after 2-4 cycles.
(exception = early-stage disease with CR on interim PET may only need only 4 cycles.)
What is in R-CHOP chemotherapy?
R: Rituximab
C: Cyclophosphamide
H: Hydroxydaunorubicin (Daunorubicin)
O: Oncovin (Vincristine)
P: Prednisone
What is POLA-R-CHP
POLA: Polatuzumab vedotin, an antibody-drug conjugate targeting CD79b on B-cells, delivering a chemotherapy drug to cancer cells.
R: Rituximab, a monoclonal antibody targeting CD20 to trigger immune destruction of B-cells.
C: Cyclophosphamide, a chemotherapy drug that damages DNA in rapidly dividing cells.
H: Hydroxydaunorubicin (doxorubicin), an anthracycline chemotherapy drug that disrupts cancer cell growth.
P: Prednisone (or prednisolone), a steroid to reduce inflammation and enhance treatment effects.
What is the mechanism of action of Rituximab?
CD-20 Monoclonal Antibody
(Complement Dependent B-Cell Cytotoxicity/ADC)
What are the formulations of Rituximab?
IV (BW) –> First Dose as an extended infusion
SQ: Flat Dose-Dependent Upon Indication
How should you pre-medicate for rituximab?
APAP + Antihistamine (Benadryl, Hydoxyzine)
What are the ADE of Rituximab?
- Infusion Reactions
- Hepatitis B Reactivation
- Gastrointestinal Perforation
- Infection
- Progressive Multifocal Leukoencephalopathy
What is the mechanism of action of Cyclophosphamide?
Alkylating Agent (Prevents Cell Division)
–> Cell Cycle (non-specific)
What formulation of cyclophosphamide is used for DBLCL?
IV
When should cyclophosphamide dose be adjuste?
Renal + Hepatic
What are the side effects of Cyclophosphamide?
- Hemorrhagic Cystitis
- Hair Loss
- Moderate-High Emetic Potential
- Bone Marrow Suppression
- Cardiotoxicity
- Pulmonary Toxicity
- Secondary Malignancy
