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Heme/Onc > Lymphomas > Flashcards

Lymphomas Flashcards

1
Q

What are risk factors for HL?

A

EBV, HIV

Immunosuppression

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2
Q

What is the presentation of HL?

A

Asymptomatic lymphadenopathy
Discovery of mediastinal mass on x-ray
B-symptoms
Pain following alcohol consumption

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3
Q

What is asymptomatic lymphadenopathy?

A

Persisting for > 1 month, may wax and wane
Painless, rubbery
Nodal involvement usually systematic or logical

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4
Q

What are B-symptoms?

A

> 10% wt loss in 6 months
Fever
Night sweats
Pruritus

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5
Q

What types of cells are associated with HL?

A

Reed-sternberg cells

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6
Q

What type of imaging technique is used to diagnose HL?

A

Integrated PET/CT scan

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7
Q

What is Stage I from Cotswolds-Ann Arbor system?

A

Single lymph node region or lymphoid structure

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8
Q

What is stage II from Cotswolds-Ann Arbor system?

A

Multiple lymph nodes on same side of diaphragm

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9
Q

What is stage III from Cotswolds-Ann Arbor system?

A

Multiple lymph nodes on both sides of diaphragm

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10
Q

What is stage IV from Cotswolds-Ann Arbor system?

A

Lymph node involvement and extensive involvement of liver, lung, bone marrow, or another extralymphatic organ

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11
Q

What does A stand for in the Cotswolds-Ann Arbor system?

A

Absence of systemic symptoms

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12
Q

What does B stand for in the Cotswolds-Ann Arbor system?

A

B symptoms

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13
Q

What does the E stand for in the Cotswolds-Ann Arbor system?

A

Extranodal involvement

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14
Q

What are unfavorable factors in HL?

A

Bulky disease (mass > 10 cm)
ESR > 50 (if asx)
> 3 sites
B symptoms

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15
Q

What are the factors used in the IPI for HL?

A 
Serum albumin (< 4)
Hgb (< 10.5)
Male
Stage IV
Age (45+)
WBC (> 15,000)
Lymphopenia (< 600 or <8% of WBC count)
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16
Q

What is the goal for HL?

A

Maximize potential for cure

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17
Q

What is the standard of care for HL?

A

ABVD

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18
Q

What is ABVD?

A

Doxorubicin
Bleomycin
Vinblastine
Dacarbazine

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19
Q

What are the stage I/II (favorable) treatment options?

A

Chemo +/- involved site radiation therapy (ISRT)

After 2-4 cycles, restage PET/CT

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20
Q

What are thestage I/II (unfavorable) and advanced disease treatment options?

A

Chemo (ABVD)

After chemo - restage, then chemo/ISRT

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21
Q

What are options for relapsed HL diseases?

A 
Autologous HSCT
HD chemo
Everolimus
Lenalidomide
Nivolumab/pembrolizumab
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22
Q

What are the RFs for NHL?

A

Genetic
Exposures
Infections

23
Q

What part of genetics affects NH:?

A

Compromised immune system: congenital and acquired immunodeficiency conditions
Cytogenetic abnormalities: t(8;14), t(14;18)**, t(11;14)

24
Q

What type of exposures are RFs for NHL?

A

Herbicides
Pesticides
Radiation
Dyes

25
Q

What infections are RFs for NHL?

A 
EBV
HIV
HTLV-1
H pylori
HCV
26
Q

What is the presentation for NHL?

A

Peripheral lymphadenopathy
B symptoms
Fatigue, malaise, pruritus
Extranodal involvement

27
Q

Is NHL peripheral lymphadenopathy systematic/logical?

A

No

28
Q

What is the diagnosis of NHL?

A

Hx and PE
Excisional node biopsy
Possibly bone marrow biopsy
Scans
Labs: CBC with dif, LDH, CMP, LFTs, Hep B
Immunophenotyping w/ immunochemistry and/or flow cytrometry

29
Q

What are the classifications of NHL?

A

Indolent
Aggressive
Highly aggressive lymphoma/acute leukemia

30
Q

What is an indolent lymphoma?

A

Follicular

31
Q

Are indolent lymphomas curable?

A

No

32
Q

Are aggressive/ highly aggressive lymphomas curable?

A

Potentially

33
Q

What is an aggressive lymphoma?

A

Diffuse large B-Cell lymphoma

34
Q

If a patient has a follicular lymphoma and remains untreated, how long is their survival?

A

Years

35
Q

If a patient has diffuse large B cell lymphoma and remains untreated, how long is their survival?

A

Months

36
Q

What factors are used in the Lugano modification staging system?

A

Nodal involvement

Extranodal status

37
Q

What is stage I per the Lugano modification?

A

Single lymph node region or lymphoid structure

Single extranodal lesion w/o nodal involvement

38
Q

What is stage II per the Lugano modification?

A

Two ore more nodal groups on same side of diaphragm

Stage I or II by nodal extent with limited contiguous extranodal involvement

39
Q

What is stage II “bulky” per the Lugano modification?

A

II with “bulky” disease

40
Q

What is stage III per the Lugano modification?

A

Nodes on both sides of diaphragm or nodes above the diaphragm with spleen involvement

41
Q

What is stage IV per the Lugano modification

A

Additional non-contiguous extralymphatic involvement

42
Q

What are RFs for NHL that lead to a worse prognosis?

A

Age > 60
High stage
B symptoms
Elevated Serum LDH

43
Q

What stages are considered localized follicular lymphoma?

A

Non-bulk Stage I or II

44
Q

What are treatment options for localized follicular lymphoma?

A

Local radiation

Watch and wait if asx or radiation toxicity is a concern

45
Q

What are considered advanced follicular lymphomas?

A

Stage III or IV

Any bulky disease

46
Q

What are the therapies for advanced follicular lymphomas?

A 
Local radiation therapy
BP
CHOP-R
RCVP
Rituximab
Radioimmunotherapy
Stem Cell transplant
47
Q

What is CHOP-R?

A

Cyclophosphamide
Doxorubicin
Vincristine
Prednisone-rituximab

48
Q

What is DLBCL?

A

Diffuse Large B Cell lymphoma

49
Q

What is the typical presentation of DLBCL?

A

Rapidly enlarging sx masses

50
Q

What is the treatment goal for DLBCL?

A

Cure

51
Q

What is the therapy for DLBCL?

A

CHOP-R +/- Locoregional Radiation therapy

52
Q

What is double hit lymphoma?

A

Type of DLBCL with MYC rearrangement and BCL2 and/or BCL6 rearrangement

53
Q

If a patient has double hit lymphoma, what does that mean for prognosis?

A

Poor

Use more intense regimens than CHOP-R

Heme/Onc (20 decks)

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