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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
Q

What percentage of lymphoma cases are B cell?

A

2/3 (66%)

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26
Q

Does B cell or T cell lymphoma have a better prognosis?

A

B cell lymphoma

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27
Q

Where are T cell lymphomas commonly found?

A

Skin, mediastinum, GI, and hepatic

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28
Q

Does B cell or T cell lymphoma have a better response to the CHOP protocol?

A

B-cell

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29
Q
  • Which one of the following lymphoma diagnostics evaluates clonality of the lymphocyte population?
    a. PARR
    b. Flow cytometry
    c. Immunohistochemistry
    d. Immunocytochemistry
A

a. PARR

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30
Q

Generally, what factors indicate prognosis in lymphoma?

A

Stage of disease, Substage, immunophenotype, anatomic form, prior prednisone use, histologic grade, hypercalcemia, anemia, and chemotherapy induced hematologic toxicity

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31
Q

What stage of lymphoma has the worse prognosis?

A

Stage 5

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32
Q

What substage of lymphoma has the worse prognosis?

A

Substage b

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33
Q

What immunophenotype of lymphoma has the worst prognosis?

A

T cell

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34
Q

What anatomic forms of lymphoma have the worse prognosis?

A

Mediastinal, GI, hepatic, and cutaneous

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35
Q

Why is prior prednisone a poor prognostic indicator?

A

It can lead to increased drug resistance

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36
Q

What histologic grade has a better prognosis?

A

low grade

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37
Q

What is the objective treatment goal for lymphoma?

A

complete response

38
Q

What is the subjective treatment goal for lymphoma?

A

Quality of life

39
Q

How do you best assess the response status for lymphoma treatment?

A

Examination/palpation, cytology, and flow cytometry/PARR

40
Q

What is the most important aspect of lymphoma treatment?

A

obtaining a complete response

41
Q

When would you use prednisone alone to treat lymphoma?

A

as a palliative option

42
Q

What is the survival time associated with using prednisone as the sole treatment?

43
Q

True or False: You should administer prednisone prior to your diagnosis of lymphoma.

44
Q

What is CCNU?

45
Q

What survival time is associated with CCNU and prednisone?

A

2-4 months - 40-50% response rate

46
Q

What is the survival time associated with Doxorubicin + prednisone?

A

5-7 months - 60-80% response rate

47
Q

What does (L) CHOP stand for?

A

L-asparaginase, cytoxan, doxorubicin, vincristine, and prednisone

48
Q

What is the survival time associated with the (L) CHOP protocol for lymphoma?

A

12 months (median) - 80-95% response

49
Q

Why would (L) CHOP not be chosen even though it is a successful lymphoma treatment?

A

It is expensive

50
Q

What is the MOA of Tanovea - CA1?

A

novel double prodrug of the anti-proliferative nucleotide analog PMEG

51
Q

*MST for high grade multicentric lymphoma treated with prednisone alone (dog)?

A

About 50 days

52
Q

*What drug is the ‘C’ in L-CHOP?

53
Q

*Method of immunophenotyping that evaluates cell size and granularity?

A

Flow cytometry

54
Q

*Most common immunophenotype of canine high grade multicentric lymphoma?

55
Q

What are the characteristics of indolent (small cell/low grade) lymphoma?

A

Indolent, slowly progressive
Incomplete responses to CHOP
Long survival times

56
Q

How does indolent lymphoma clinically present?

A 
Middle-age to older dogs
Substage a
Incidental finding by owner/veterinarian
Local disease or multicentric
no hypercalcemia reported
57
Q

Is indolent lymphoma most often B cell or T cell?

58
Q

How is indolent lymphoma diagnosed?

A

Clinical history, cytology, tissue biopsies and histopathology, and flow cytometry

59
Q

What clinical history do patients with indolent lymphoma often have?

A

Chronically enlarged lymph nodes that are waxing and waning in size

60
Q

True or False: Cytology is enough to diagnose indolent lymphoma.

A

False - it is not enough

61
Q

What is the best option for diagnosis of indolent lymphoma?

A

Tissue biopsies and histopathology

62
Q

What is the second best option for diagnosis of indolent lymphoma?

A

flow cytometry

63
Q

What are the recommendations for indolent lymphoma?

A

Regular clinical staging, often no treatment

64
Q

When indicated, what treatment is recommended for indolent lymphoma?

A

Chlorambucil with prednisone

65
Q
  • 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
A

e. histopathology and IHC

66
Q

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

A

e. No treatment/monitor

67
Q

What does ‘ALL’ stand for?

A

acute lymphoblastic leukemia

68
Q

What history/clinical signs are associated with ALL?

A

Anorexia, weight loss
Splenomegaly, hepatomegaly, and peripheral lymphadenopathy
Hemorrhage, petechiation

69
Q

What diagnostics can be used for ALL?

A

CBC, flow cytometry, and bone marrow aspirate

70
Q

What will you find on CBC in patients with ALL?

A

Marked lymphocytosis, neutropenia, thrombocytopenia, and anemia

71
Q

How is ALL treated?

A

CHOP-based chemotherapy is the most common

Supportive care

72
Q

What supportive care is recommended for patients with ALL?

A

blood transfusions, antimicrobials, and nutrition

73
Q

What is the prognosis for ALL?

A

Poor - extremely short survival typically (weeks to few months)

74
Q

What does CLL stand for?

A

Chronic lymphocytic leukemia

75
Q

What history and clinical signs are associated with CLL?

A

Often asymptomatic - lethargy, decreased appetite

Mild lymphadenopathy, splenomegaly

76
Q

What diagnostics are recommended for CLL?

A

CBC, flow cytometry, and bone marrow aspirate

77
Q

What CBC findings are consistent with a patient with CLL?

A

Variable lymphocytosis (small/normal)

78
Q

How is CLL treated?

A

Active surveillance

Chlorambucil + prednisone if indicated

79
Q

When is Chlorambucil and prednisone indicated in patients with CLL?

A

Anemia, thrombocytopenia, lymphadenopathy, hepato- and/or splenomegaly or high lymphocytosis

80
Q

What is the prognosis for patients with CLL?

A

Generally slowly progressive
Reported survival time - 480-930 days
Many dogs will not require therapy for a significant time after diagnosis

81
Q

What is the signalment for GI lymphoma in cats?

A

Older, FeLV-negative cats

82
Q

What clinical signs are associated with GI lymphoma in cats?

A

Vomiting, diarrhea, weight loss, and inappetence

These CS make it difficult to diagnose because it is consistent with chronic enteropathy as well

83
Q

The majority of feline lymphoma cases are mucosal/cutaneous, low-grade/high grade, and Tcell/Bcell.

A

mucosal. low-grade, T-cell

84
Q

*Lymphoma is currently diagnosed most commonly in older, feline leukemia virus (FeLV) positive/negative cats.

85
Q

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.

A

low, t-cell, small

86
Q

What is the first-line therapy for small cell GI lymphoma in cats?

A

Chlorambucil and prednisolone

87
Q

What are the rescue therapy options for small cell GI lymphoma treatment in cats?

A

Lomustine (CCNU), cyclophosphamide, and vinblastine

88
Q

What is the prognosis of small T-cell GI lymphoma in cats?

A

Good prognosis - response rates >90% and median survival often greater than or equal to 2 years

89
Q

What is the recommended treatment for high grade/large cell GI lymphoma in cats?

A

More aggressive CHOP/COP chemotherapy

90
Q

What is the prognosis for high grade/large cell GI lymphoma in cats?

A

45-100 days

Small Animal Medicine (100 decks)

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