Staging and Prognostic Factors

Question 1

B symptoms

Answer 1

1. Weight loss > 10% from baseline in 6 months
2. Unexplained temp > 38 degrees celsius or 100.4 F
3. Drenching nightsweats

Question 2

IPI Score

Answer 2

1. Age > 60
2. Stage III/IV
3. ECOG PS 2+
4. Elevated LDH
5. 2+ extranodal sites

Question 3

Stage Adjusted IPI Score

Answer 3

1. Age > 60
2. Stage II
3. ECOG PS 2+
4. Elevated LDH

Question 4

Age Adjusted IPI

Answer 4

1. Stage III/IV
2. ECOG PS 2+
3. Elevated LDH

Question 5

Stage I

Answer 5

Patients with a single nodal region involved with disease are Stage I.

Patients with a single extralymphatic site have Stage IE.

Question 6

Stage II

Answer 6

Patients with more than one nodal region on the same side of the diaphragm. It can also include patients with a single nodal region in close proximity to an extralymphatic site.

Question 7

Stage III

Answer 7

Patients who have nodal disease above and below the diaphragm.

Question 8

Stage IV

Answer 8

1. Patients with involvement of the bone marrow or liver. Elevated LFTs can indicate Stage IV disease
2. Patients with lung disease without direct extension from a nodal region.
3. Patients with diffuse infiltration of an organ have stage IV disease.
4. Patients with a single extralymphatic site located separate from a nodal region have stage IV disease. This can be the case even if disease is located on the same side of the diaphragm.

Question 9

A and B designation

Answer 9

A means no B symptoms

B means B symptoms were present at time of diagnosis

Question 10

5 year OS by IPI Score

Answer 10

0-1: 73%
2: 51%
3: 43%
4-5: 26%

Question 11

5 year OS by IPI Score when Rituxan is used?

Answer 11

0-1: 94%
2: 79%
3-5: 55%

Question 12

What are the LN stations defined by the Rye symposium?

Answer 12

1. Waldeyer ring
2. Occipital, cervical, preauricular, and supraclavicular
3. Infraclavicular
4. Axillary
5. Epitrochlear
6. Mediasinum
7. Right hilum
8. Left hilum
9. Paraaortic
10. Spleen
11. Mesenteric
12. Iliac
13. Inguinofemoral
14. Popliteal

Question 13

How is bulky disease defined when outside of the mediastinum?

Answer 13

Some studies indicate bulky disease is more than 5 cm, others indicate that it is when disease is more than 10 cm.

Question 14

How is MTR defined?

Answer 14

Mass greater than 1/3 the intrathoracic diameter at T5-6 on an upright PA film

Question 15

What percentage of patients present with Stage I?

Answer 15

18%

Question 16

What percentage of patients present with Stage II?

Answer 16

47%

Question 17

What percentage of patients present with Stage III?

Answer 17

12%

Question 18

What percentage of patients present with Stage IV?

Answer 18

14%