SET8 Flashcards
When can ABVD be given in pregnancy?
It can be safely given during the first trimester
Bulky disease in Hodgkin is defined how?
LN greater than 10 cm; often requires involved site radiation (ISRT) or involved field radiation (IFRT)
What is NLPHL?
Nodular Lymphocyte Predominant Hodgkin Lymphoma (CD20+, CD15/30 -)
What are some types of medications that can be used in Cutaneous T cell Lymphomas?
Alfa-interferon, Bexarotene (vitamin A derivative) and HDAC inhibitors
Which type of Hodgkin Lymphoma can Rituximab be used in?
Nodular Lymphocyte Predominant (it is CD20+)
What is the standard of care for relapsed or primary refractory Hodgkin Lymphoma?
High Dose Therapy w/ Auto transplant (HDT/ASCR); now with new evidence from AETHERA study that adding Brentuximab Vedotin has shown increased PFS
What is it called when Castleman Disease involves one Nodal site vs. multiple?
Unicentric Castleman Disease; Multicentric Castleman Disease
What generally leads to high cure rates in patients with Stage IA-IIA non-bulky Hodgkins?
Short course of ABVD followed by involved field radiation (RAPID study)
What IL-6 inhibitor is approved for Multicentric Castleman Disease patients who are both HIV- and HHV-8-?
Siltuximab
What are some poor prognostications of DLBCL?
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
In Hodgkin what does HDT/ASCR stand for?
High Dose Therapy; Autologous Stem Cell Rescue
What are the 5 adverse features for early stage (I-II; cf. to advanced stage)
Bulky mediastinal disease, disease >10 cm, constitutional B sx, ESR >50, >3 sites of disease
What is another name for Castleman’s Disease?
Angiofollicular Lymph Node Hyperplasia
Can you use BEACOPP in both early stage and advanced stage Hodgkin?
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
Describe the microscopic appearance of nodular sclerosing Hodgkin Lymphoma
Lacunar Reed-Sternberg cells that are prominently seen in a background of cells including eosinophils, lymphocytes with collagen sclerosis
How is Nodular Lymphocyte Predominant Hodgkin different from the other types?
It is CD20+ but CD15 and CD30- and it is MOSTLY seen as early stage disease
What can you say about relapse and transformation of nodular lymphocyte predominant Hodgkin vs. other types?
More commonly has late relapses and more commonly transforms into DLBCL; HOWEVER, it is also more commonly diagnosed as early disease
This is usually CD30+, CD15+, and CD20-
Classical Hodgkin Lymphoma
What are the Sx of Castleman Disease? Why?
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)
What is the standard of care for Unicentric Castleman Disease? Multicentric?
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
What are the 7 adverse risk factors of advanced stage Hodgkin disease?
Stage IV Dz, Age >45, Albumin <4, Hgb <10.5, WBC >15k, Lymphocyte count <600, male gender
What is the best situation in which to obtain BCR-ABL mutational testing ?
If someone is progressing on their TKI
In whom is BEACOPP a reasonable consideration?
Patients with 4 or more adverse risk factors for advanced stage Hodgkin (but is toxic so avoid if over 60)
What are the most common forms of Cutaneous T-cell Lymphomas?
Mycosis fungoides and Sezary syndrome
What gender is an adverse risk factor for advanced stage Hodgkin’s Lymphoma?
Male
What are the 5 types of Hodgkin lymphoma
Nodular sclerosing, Mixed cellularity, Lymphocyte rich, lymphocyte depleted, and nodular lymphoctye predominant (the one that is CD20+ and CD15/30-)
What are Reed-Sternberg Cells?
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
What is Siltuximab and in whom is it approved?
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-
What is the difference in treatment of Stage I Nodular Lymphocyte Predominant Hodgkin Dz in comparison to other types (i.e. “Classical Hodgkin”)?
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-
In whom is Brentuximab Vedotin approved?
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
This drug targets CD30 and deploys monomethyl Auristatin E inside the tumor cell. Used in these 2 tumors _______
Brentuximab Vedotin; Hodgkin Lymphoma (usually relapsed) and Anaplastic Large Cell Lymphoma
What regimen is considered for those with 4 or more adverse features in advanced stage Hodgkin?
BEACOPP (Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Vincristine (oncovin), Procarbazine, and Prednisone
Adverse features of Hodgkin lymphoma depend on what?
Stage. Adverse risk factors for Stage IA/IIA such as elevated ESR and constitutional Sx are different from those with advanced stage Hodgkin
Hodgkin lymphoma and _______ both express CD30 and can both be treated with _______
Anaplastic Large Cell Lymphoma; Brentuximab Vedotin which is a drug that targets CD30 and deploys Monomethyl Auristatin E inside the tumor cell
What is DHAP? Who is is used in?
Dexamethasone, Cytarabine, Cisplatin used as salvage for Hodgkin
What are the AE of Idelalisib (Zydelig)?
INTESTINAL PERFORATION, pneumonitis, colitis, liver toxicity and diarrhea
What is Angiofollicular Lymph Node Hyperplasia also known as?
Castleman’s Disease
What virus is often implicated in Angiofollicular Lymph Node Hyperplasia?
HHV-8 (aka Castleman Disease)
What is unique about Nodular Lymphocyte Predominant Hodgkin Lymphoma?
It is CD20+ and so Rituximab can be used (generally not as monotherapy though as ABVD still superior)
Where is t(14;18) usually seen? What if it occurs in DLBCL?
Follicular Lymphoma; it confers a worse prognosis when present in DLBCL
Define Early Stage favorable disease in Hodgkin Lymphoma
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)
This is an oral inhibitor of PI3K-delta used in high risk or relapsed CLL/SLL and potentially in refractory follicular lymphoma
Idelalsib (Zydelig)
What is the most common subtype of Hodgkin disease? Second most common?
MC = Nodular sclerosing Hodgkin; 2nd MC = Mixed Cellularity
In general what serum EPO level portends a good response to ESAs in patients with MDS?
EPO <500, if the EPO is sky high then an ESA such as Darbepoeitin alpha is not going to be very useful
What urologic issue can occur due to hyperleukocytosis?
Priapism
Mixed Cellularity Hodgkin Lymphoma is often assoc with what infxn?
EBV
