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Oncology - Lymphoma/Leukemia 2 Flashcards

1
Q

Define stage I lymphoma.

A

Involvement of LN or organ

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2
Q

Define stage II lymphoma.

A

Involvement of 1 or more regional lymph nodes

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3
Q

Define stage III lymphoma.

A

Generalized LN involvement

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4
Q

Define stage IV lymphoma.

A

Liver/spleen involvement

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5
Q

Define stage V lymphoma.

A

Bone marrow involvement or other organs

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6
Q

Define substage A.

A

Healthy - absence of significant clinical signs

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7
Q

Define substage B.

A

Sick - clinical signs attributable to systemic disease

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8
Q

True or False: Stage I-IV have a similar prognosis.

A

True

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9
Q

Which substage has a worse prognosis?

A

substage B

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10
Q

What are the diagnostic methods that can aid in staging?

A

Minimum database
Thoracic radiographs
Abdominal rads and/or ultrasound

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11
Q

If you are going to do the bare minimum for staging, what tests should be done?

A

CBC, chemistry, and UA

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12
Q
  • A dog with lymphoma being presented with peripheral lymphadenopathy and uveitis would be classified with what stage of disease?
    a. Stage 1
    b. Stage 2
    c. Stage 3
    d. Stage 4
    e. Stage 5

*his question

A

e. Stage 5

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13
Q

What are the different types of immunophenotyping that can determine the difference between B cell or T cell lymphoma?

A

Immunohistochemistry
Immunocytochemistry
Flow cytometry
PARR

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14
Q

What is the gold standard for immunophenotyping between B and T cell lymphoma?

A

Immunohistochemistry

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15
Q

What samples do immunohistochemistry use?

A

Histopathology/biopsy sample

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16
Q

What samples do immunocytochemistry use?

A

cytology

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17
Q

What are the advantages of knowing if it is B cell or T cell lymphoma?

A

Prognostic indicator

May change treatment options

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18
Q

How do you test for lymphocyte clonality?

A

PCR for antigen receptor rearrangement

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19
Q

What does a polyclonal PARR response indicate?

A

reactive

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20
Q

What does a monoclonal PARR response indicate?

A

neoplastic

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21
Q

What is PARR performed on?

A

Blood, bone marrow, lymph node aspirates, effusion, and mediastinal mass

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22
Q

What does PARR test for?

A

clonality to distinguish reactive lymphocytosis vs. lymphoma (slide says leukemia but I feel like its a typo)

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23
Q

What is flow cytometry performed on (in the context of lymphoma)?

A

Blood, bone marrow, LN, effusion, and mediastinal mass

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24
Q

What does flow cytometry test for?

A

a panel of antibodies - phenotype, subtype, MHCII, etc.

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25
What percentage of lymphoma cases are B cell?
2/3 (66%)
26
Does B cell or T cell lymphoma have a better prognosis?
B cell lymphoma
27
Where are T cell lymphomas commonly found?
Skin, mediastinum, GI, and hepatic
28
Does B cell or T cell lymphoma have a better response to the CHOP protocol?
B-cell
29
* Which one of the following lymphoma diagnostics evaluates clonality of the lymphocyte population? a. PARR b. Flow cytometry c. Immunohistochemistry d. Immunocytochemistry
a. PARR
30
Generally, what factors indicate prognosis in lymphoma?
Stage of disease, Substage, immunophenotype, anatomic form, prior prednisone use, histologic grade, hypercalcemia, anemia, and chemotherapy induced hematologic toxicity
31
What stage of lymphoma has the worse prognosis?
Stage 5
32
What substage of lymphoma has the worse prognosis?
Substage b
33
What immunophenotype of lymphoma has the worst prognosis?
T cell
34
What anatomic forms of lymphoma have the worse prognosis?
Mediastinal, GI, hepatic, and cutaneous
35
Why is prior prednisone a poor prognostic indicator?
It can lead to increased drug resistance
36
What histologic grade has a better prognosis?
low grade
37
What is the objective treatment goal for lymphoma?
complete response
38
What is the subjective treatment goal for lymphoma?
Quality of life
39
How do you best assess the response status for lymphoma treatment?
Examination/palpation, cytology, and flow cytometry/PARR
40
What is the most important aspect of lymphoma treatment?
obtaining a complete response
41
When would you use prednisone alone to treat lymphoma?
as a palliative option
42
What is the survival time associated with using prednisone as the sole treatment?
50 days
43
True or False: You should administer prednisone prior to your diagnosis of lymphoma.
False
44
What is CCNU?
Lomustine
45
What survival time is associated with CCNU and prednisone?
2-4 months - 40-50% response rate
46
What is the survival time associated with Doxorubicin + prednisone?
5-7 months - 60-80% response rate
47
What does (L) CHOP stand for?
L-asparaginase, cytoxan, doxorubicin, vincristine, and prednisone
48
What is the survival time associated with the (L) CHOP protocol for lymphoma?
12 months (median) - 80-95% response
49
Why would (L) CHOP not be chosen even though it is a successful lymphoma treatment?
It is expensive
50
What is the MOA of Tanovea - CA1?
novel double prodrug of the anti-proliferative nucleotide analog PMEG
51
*MST for high grade multicentric lymphoma treated with prednisone alone (dog)?
About 50 days
52
*What drug is the 'C' in L-CHOP?
Cytoxan
53
*Method of immunophenotyping that evaluates cell size and granularity?
Flow cytometry
54
*Most common immunophenotype of canine high grade multicentric lymphoma?
B cell
55
What are the characteristics of indolent (small cell/low grade) lymphoma?
Indolent, slowly progressive Incomplete responses to CHOP Long survival times
56
How does indolent lymphoma clinically present?
``` Middle-age to older dogs Substage a Incidental finding by owner/veterinarian Local disease or multicentric no hypercalcemia reported ```
57
Is indolent lymphoma most often B cell or T cell?
T cell
58
How is indolent lymphoma diagnosed?
Clinical history, cytology, tissue biopsies and histopathology, and flow cytometry
59
What clinical history do patients with indolent lymphoma often have?
Chronically enlarged lymph nodes that are waxing and waning in size
60
True or False: Cytology is enough to diagnose indolent lymphoma.
False - it is not enough
61
What is the best option for diagnosis of indolent lymphoma?
Tissue biopsies and histopathology
62
What is the second best option for diagnosis of indolent lymphoma?
flow cytometry
63
What are the recommendations for indolent lymphoma?
Regular clinical staging, often no treatment
64
When indicated, what treatment is recommended for indolent lymphoma?
Chlorambucil with prednisone
65
* The diagnoses of indolent lymphoma is best made by: a. history and clinical signs b. PARR c. cytology d. treatment response e. Histopathology and IHC
e. histopathology and IHC
66
The preferred initial treatment for most dogs with indolent lymphoma is: a. An abbreviated CHOP-based protocol b. Prednisone c. CCNU (lomustine) d. Doxorubicin e. No treatment/monitor
e. No treatment/monitor
67
What does 'ALL' stand for?
acute lymphoblastic leukemia
68
What history/clinical signs are associated with ALL?
Anorexia, weight loss Splenomegaly, hepatomegaly, and peripheral lymphadenopathy Hemorrhage, petechiation
69
What diagnostics can be used for ALL?
CBC, flow cytometry, and bone marrow aspirate
70
What will you find on CBC in patients with ALL?
Marked lymphocytosis, neutropenia, thrombocytopenia, and anemia
71
How is ALL treated?
CHOP-based chemotherapy is the most common | Supportive care
72
What supportive care is recommended for patients with ALL?
blood transfusions, antimicrobials, and nutrition
73
What is the prognosis for ALL?
Poor - extremely short survival typically (weeks to few months)
74
What does CLL stand for?
Chronic lymphocytic leukemia
75
What history and clinical signs are associated with CLL?
Often asymptomatic - lethargy, decreased appetite | Mild lymphadenopathy, splenomegaly
76
What diagnostics are recommended for CLL?
CBC, flow cytometry, and bone marrow aspirate
77
What CBC findings are consistent with a patient with CLL?
Variable lymphocytosis (small/normal)
78
How is CLL treated?
Active surveillance | Chlorambucil + prednisone if indicated
79
When is Chlorambucil and prednisone indicated in patients with CLL?
Anemia, thrombocytopenia, lymphadenopathy, hepato- and/or splenomegaly or high lymphocytosis
80
What is the prognosis for patients with CLL?
Generally slowly progressive Reported survival time - 480-930 days Many dogs will not require therapy for a significant time after diagnosis
81
What is the signalment for GI lymphoma in cats?
Older, FeLV-negative cats
82
What clinical signs are associated with GI lymphoma in cats?
Vomiting, diarrhea, weight loss, and inappetence These CS make it difficult to diagnose because it is consistent with chronic enteropathy as well
83
The majority of feline lymphoma cases are mucosal/cutaneous, low-grade/high grade, and Tcell/Bcell.
mucosal. low-grade, T-cell
84
*Lymphoma is currently diagnosed most commonly in older, feline leukemia virus (FeLV) positive/negative cats.
negative
85
Gastrointestinal (GI) lymphoma diagnosed in cats is most frequently low/high grade and B-cell/T-cell in origin, occurring most commonly in the small/large intestines.
low, t-cell, small
86
What is the first-line therapy for small cell GI lymphoma in cats?
Chlorambucil and prednisolone
87
What are the rescue therapy options for small cell GI lymphoma treatment in cats?
Lomustine (CCNU), cyclophosphamide, and vinblastine
88
What is the prognosis of small T-cell GI lymphoma in cats?
Good prognosis - response rates >90% and median survival often greater than or equal to 2 years
89
What is the recommended treatment for high grade/large cell GI lymphoma in cats?
More aggressive CHOP/COP chemotherapy
90
What is the prognosis for high grade/large cell GI lymphoma in cats?
45-100 days

Small Animal Medicine (100 decks)

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