Burkitt's Flashcards

1
Q

What are the 3 variants of Burkitt’s Lymphoma?

A

1) Endemic
- a/w EBV, Equatorial Africa
2) Sporadic 1%
3) Immunodeficiency related

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2
Q

What is the diagnostic criteria for Burkitt’s ?

A

CD20+
CD10+
BCL-6+
CD43+

BCL2-
CD5-

Ki67 >95%

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3
Q

What is the diagnostic criteria for Double-hit lymphomas?

A

CD20+
BCL2+
CD43+

BCL6+/-
CD10+/-
CD5+/-

Ki67>90%

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4
Q

What cytogenetics do you know about Burkitt’s?

A

80% of BL has t(8;14)
- juxtaposition of c-myc gene on chromosome 8 with IgH enhancer elements on chr 14

20% of BL cases:

  • t(2;8)(p12;q24)
  • t(8;22)(q24;q11)
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5
Q

What are the possible treatments for Burkitt’s Lymphoma?

A

1) Standford Regimen
2) CODOX-M
3) CODOX-M/IVAC
4) Hyper-CVAD
5) LMP 84,86 and 89
6) BNHL-86
7) CALGB 9251

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6
Q

What is the Standford Regimen made up of?

A
Cyclophosphamide 1200 mg/m2 D1
Doxorubicin 40 mg/m2 D1
Vincristine 1.4mg/m2 (max 2 mg) D1
Prednisone 40mg/m2 D1-5
MTX 3000 mg/m2 (with Leucovorin rescue) D10
IT MTX 12mg D1 and D10
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7
Q

What are the NCCN suggested treatments?

A

CHOP is not adequate therapy

Combination therapy required

Low Risk:
- CALGB 10002 Regimen
- CODOX-M (original or modified)
- DA-REPOCH
>> Regimen includes IT MTX)
>> minimum 3 cycles with one additional cycle beyond CR 
- HyperCVAD
High Risk:
- CALGB 10002 Regimen
>> prophylactic CNS irradiation in select patients 
- CODOX-M (original or modified)
>> alternating with IVAC 
- DA-REPOCH
- HyperCVAD 

2nd-line Therapy: (Select pts with reasonable remission)

  • No definitive 2nd-line therapies*
  • DA-REPOCH (minimum 3 cycles with one additional cycle beyond CR)
  • RICE + IT MTX if not given previously
  • RIVAC + IT MTX if not given previously
  • RGDP
  • High-dose Cytarabine + RItuximab
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8
Q

What are the Laboratory hallmarks for TLS?

A

High potassium
High uric acid
High phosphorous
Low calcium

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9
Q

What are the high-risk features for TLS?

A

Burkitt’s Lymphoma, Lymphoblastic Lymphoma
Occ DLBCL, CLL
Spontaneous TLS
Elevated WBC
BM involvement
Ineffectiveness of allopurinol
Renal disease or renal involvement by tumor

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10
Q

When is Rasburicase indicated?

A

Presence of any high-risk features
Urgent need to initiate therapy in a high-bulk patient
Situations where adequate hydration may be difficult or impossible
ARF

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11
Q

What is the danger of TLS?

A
ARF
Cardiac arrhythmias
Seizures
Loss of muscle control
Death
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12
Q

How to dose Rasburicase?

A

One dose usually enough
3-6mg usually effective

Redosing should be individualized

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13
Q

What are the antiviral options available?

A
Entecavir (preferred)
Avoid Lamivudine due to resistance development 
Adefovir 
Telbivudine
Tenofovir
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14
Q

How long to maintain prophylaxis for ? For Hep B

A

12 months after oncological treatment ends

But need to consult hematologist for duration if active HBV

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