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MALIGNANT HEME > SET8 > Flashcards

SET8 Flashcards

1
Q

When can ABVD be given in pregnancy?

A

It can be safely given during the first trimester

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2
Q

Bulky disease in Hodgkin is defined how?

A

LN greater than 10 cm; often requires involved site radiation (ISRT) or involved field radiation (IFRT)

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3
Q

What is NLPHL?

A

Nodular Lymphocyte Predominant Hodgkin Lymphoma (CD20+, CD15/30 -)

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4
Q

What are some types of medications that can be used in Cutaneous T cell Lymphomas?

A

Alfa-interferon, Bexarotene (vitamin A derivative) and HDAC inhibitors

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5
Q

Which type of Hodgkin Lymphoma can Rituximab be used in?

A

Nodular Lymphocyte Predominant (it is CD20+)

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6
Q

What is the standard of care for relapsed or primary refractory Hodgkin Lymphoma?

A

High Dose Therapy w/ Auto transplant (HDT/ASCR); now with new evidence from AETHERA study that adding Brentuximab Vedotin has shown increased PFS

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7
Q

What is it called when Castleman Disease involves one Nodal site vs. multiple?

A

Unicentric Castleman Disease; Multicentric Castleman Disease

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8
Q

What generally leads to high cure rates in patients with Stage IA-IIA non-bulky Hodgkins?

A

Short course of ABVD followed by involved field radiation (RAPID study)

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9
Q

What IL-6 inhibitor is approved for Multicentric Castleman Disease patients who are both HIV- and HHV-8-?

A

Siltuximab

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10
Q

What are some poor prognostications of DLBCL?

A

Myc amplification, activated B cell type (ABC) or double hit lymphoma- myc and BCL2 expression; additionally t(14;18) which is usually seen in follicular lymphoma, when seen in DLBCL is bad

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11
Q

In Hodgkin what does HDT/ASCR stand for?

A

High Dose Therapy; Autologous Stem Cell Rescue

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12
Q

What are the 5 adverse features for early stage (I-II; cf. to advanced stage)

A

Bulky mediastinal disease, disease >10 cm, constitutional B sx, ESR >50, >3 sites of disease

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13
Q

What is another name for Castleman’s Disease?

A

Angiofollicular Lymph Node Hyperplasia

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14
Q

Can you use BEACOPP in both early stage and advanced stage Hodgkin?

A

Yes if there are adverse risk factors for early stage but really it is mostly used for advanced stage with 4 or more adverse risk factors

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15
Q

Describe the microscopic appearance of nodular sclerosing Hodgkin Lymphoma

A

Lacunar Reed-Sternberg cells that are prominently seen in a background of cells including eosinophils, lymphocytes with collagen sclerosis

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16
Q

How is Nodular Lymphocyte Predominant Hodgkin different from the other types?

A

It is CD20+ but CD15 and CD30- and it is MOSTLY seen as early stage disease

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17
Q

What can you say about relapse and transformation of nodular lymphocyte predominant Hodgkin vs. other types?

A

More commonly has late relapses and more commonly transforms into DLBCL; HOWEVER, it is also more commonly diagnosed as early disease

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18
Q

This is usually CD30+, CD15+, and CD20-

A

Classical Hodgkin Lymphoma

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19
Q

What are the Sx of Castleman Disease? Why?

A

Lymph Node Hyperplasia, fever, weight loss as well as leukopenia and anemia (it is thought that the B cells release IL-6 and cause the Sx)

20
Q

What is the standard of care for Unicentric Castleman Disease? Multicentric?

A

Unicentric = surgical resection; Multicentric does not have SOC but can be given chemo, steroids, and immunomodulatory drugs; if HIV- and HHV-8- can give Siltuximab, an IL-6 inhibitor

21
Q

What are the 7 adverse risk factors of advanced stage Hodgkin disease?

A

Stage IV Dz, Age >45, Albumin <4, Hgb <10.5, WBC >15k, Lymphocyte count <600, male gender

22
Q

What is the best situation in which to obtain BCR-ABL mutational testing ?

A

If someone is progressing on their TKI

23
Q

In whom is BEACOPP a reasonable consideration?

A

Patients with 4 or more adverse risk factors for advanced stage Hodgkin (but is toxic so avoid if over 60)

24
Q

What are the most common forms of Cutaneous T-cell Lymphomas?

A

Mycosis fungoides and Sezary syndrome

25
Q

What gender is an adverse risk factor for advanced stage Hodgkin’s Lymphoma?

A

Male

26
Q

What are the 5 types of Hodgkin lymphoma

A

Nodular sclerosing, Mixed cellularity, Lymphocyte rich, lymphocyte depleted, and nodular lymphoctye predominant (the one that is CD20+ and CD15/30-)

27
Q

What are Reed-Sternberg Cells?

A

Cells that are bilobed, derived from B lymphocytes resembling Owl’s eyes- seen in Hodgkin but can also be seen in mononucleosis and other lymphomas

28
Q

What is Siltuximab and in whom is it approved?

A

IL-6 inhibitor and is approved for patients with Multicentric Castlemans (more than one LN, Angiofollicular Lymph Node Hyperplasia) who are both HIV- and HHV-8-

29
Q

What is the difference in treatment of Stage I Nodular Lymphocyte Predominant Hodgkin Dz in comparison to other types (i.e. “Classical Hodgkin”)?

A

ISRT because they have a more indolent course than other types; NOTE if it is not Stage I this doesnt count; recall that Nodular Lymphocyte Predominant has CD20+ and CD15/CD30-

30
Q

In whom is Brentuximab Vedotin approved?

A

Hodgkin after failure of auto-transplant or after at least 2 prior chemo regimens; anaplastic large cell lymphoma after failure of at least one multi-agent chemo regimen

31
Q

This drug targets CD30 and deploys monomethyl Auristatin E inside the tumor cell. Used in these 2 tumors _______

A

Brentuximab Vedotin; Hodgkin Lymphoma (usually relapsed) and Anaplastic Large Cell Lymphoma

32
Q

What regimen is considered for those with 4 or more adverse features in advanced stage Hodgkin?

A

BEACOPP (Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Vincristine (oncovin), Procarbazine, and Prednisone

33
Q

Adverse features of Hodgkin lymphoma depend on what?

A

Stage. Adverse risk factors for Stage IA/IIA such as elevated ESR and constitutional Sx are different from those with advanced stage Hodgkin

34
Q

Hodgkin lymphoma and _______ both express CD30 and can both be treated with _______

A

Anaplastic Large Cell Lymphoma; Brentuximab Vedotin which is a drug that targets CD30 and deploys Monomethyl Auristatin E inside the tumor cell

35
Q

What is DHAP? Who is is used in?

A

Dexamethasone, Cytarabine, Cisplatin used as salvage for Hodgkin

36
Q

What are the AE of Idelalisib (Zydelig)?

A

INTESTINAL PERFORATION, pneumonitis, colitis, liver toxicity and diarrhea

37
Q

What is Angiofollicular Lymph Node Hyperplasia also known as?

A

Castleman’s Disease

38
Q

What virus is often implicated in Angiofollicular Lymph Node Hyperplasia?

A

HHV-8 (aka Castleman Disease)

39
Q

What is unique about Nodular Lymphocyte Predominant Hodgkin Lymphoma?

A

It is CD20+ and so Rituximab can be used (generally not as monotherapy though as ABVD still superior)

40
Q

Where is t(14;18) usually seen? What if it occurs in DLBCL?

A

Follicular Lymphoma; it confers a worse prognosis when present in DLBCL

41
Q

Define Early Stage favorable disease in Hodgkin Lymphoma

A

Stage IA-IIA w/ no bulky disease, 1-2 involved nodal sites, low ESR (<50), lack of constitutional B sx (if B Sx present would be stage IB or stage IIB could not call it Stage I/IIA)

42
Q

This is an oral inhibitor of PI3K-delta used in high risk or relapsed CLL/SLL and potentially in refractory follicular lymphoma

A

Idelalsib (Zydelig)

43
Q

What is the most common subtype of Hodgkin disease? Second most common?

A

MC = Nodular sclerosing Hodgkin; 2nd MC = Mixed Cellularity

44
Q

In general what serum EPO level portends a good response to ESAs in patients with MDS?

A

EPO <500, if the EPO is sky high then an ESA such as Darbepoeitin alpha is not going to be very useful

45
Q

What urologic issue can occur due to hyperleukocytosis?

A

Priapism

46
Q

Mixed Cellularity Hodgkin Lymphoma is often assoc with what infxn?

A

EBV

MALIGNANT HEME (12 decks)

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