03c: Hodgin's, NHL

Question 1

T/F: Lymphomas are the most common cancer in young adults.

Answer 1

True - 20%

Question 2

T/F: For Lymphoma diagnosis, biopsy can be excisional, core needle, or fine needle aspiration.

Answer 2

False - fine needle aspiration not acceptable

Question 3

Ann Arbor staging for lymphoma: spread to L inguinal, axillary nodes and spleen.

Answer 3

Stage III (nodal distribution on both sides of diaphragm)

Note: Spleen is considered nodal (not extranodal) site

Question 4

Ann Arbor staging for lymphoma: what constitutes Stage IV?

Answer 4

Extranodal involvement (liver, lung, bone marrow)

Question 5

Ann Arbor staging for lymphoma: if only liver (no nodal sites) involved, which stage?

Answer 5

1E

Question 6

Hodgkin lymphoma: median age of pt is (X) and this type constitutes (Y)% of all lymphomas.

Answer 6

X = 26
Y = 30

Question 7

Hodgkin lymphoma: there’s a 3-fold risk of disease if patient has med Hx of (X)

Answer 7

X = mononucleosis

Question 8

Most common type of Hodgkin lymphoma:

Answer 8

Nodular sclerosis HL

Question 9

Cancer: Ki-67 measures…

Answer 9

Proliferative rate

Question 10

Early Hodgkin therapy: (chemo/radiation), then (chemo/radiation) if needed.

Answer 10

Chemo; radiation

Question 11

Which combo chemo therapy is used for Hodgkin? How many cycles?

Answer 11

ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine)

6 cycles (1 cycle = 2 treatments)

Question 12

Dose Limiting toxicity of

alkylating agents is which Sx?

Answer 12

myelosuppression

Question 13

B cell maturation: CD(19/20) becomes positive at an earlier stage than CD(19/20). Which is mainly used in CAR-T cell therapy?

Answer 13

19; 20

CD19 (since effective against all lymphomas and against more immature pre-B cells in ALL)

Question 14

Why would you expect malignant cells in MM to be CD20 (pos/neg).

Answer 14

Neg;

Plasma cells don’t express CD20

Question 15

BCL2 associated with which translocation? Seen in which NHL?

Answer 15

t(14;18)

Follicular lymphoma

Question 16

Myc associated with which translocation? Seen in which NHL?

Answer 16

t(8;14)

Burkitt’s

Question 17

T/F: Unlike Hodgkin, NHL is a disease of the elderly.

Answer 17

True

Question 18

Although there are 43 different types of NHL, there are only 3 treatment paradigms. What are they?

Answer 18

1. Indolent (untreated survival measured in years)
2. Aggressive (measured in months)
3. Highly aggressive (measured in weeks)

Question 19

Follicular lymphoma falls into which NHL treatment paradigm?

Answer 19

Indolent (if grade I/II)

Aggressive (if grade III)

Question 20

Diffuse large B-cell lymphoma falls into which NHL treatment paradigm?

Answer 20

Aggressive

Question 21

Burkitt lymphoma falls into which NHL treatment paradigm?

Answer 21

Highly aggressive

Question 22

DLBCL Treatment for Stage I/II (localized):

Answer 22

Abbreviated chemo with immunotherapy and maybe radiation

Question 23

DLBCL Treatment for Advanced-stage disease:

Answer 23

Rituximab and CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)

Question 24

Localized (earlier stage) follicular lymphoma Rx:

Answer 24

Locoregional/extended-field radiation

Question 25

Advanced stage, asymptomatic follicular lymphoma Rx:

Answer 25

Observation or systemic therapy

Question 26

Follicular lymphoma: conventional therapy, using (X), is not curable. But a subset of patients may be cured with (Y).

Answer 26

X = rituximab (combo with chemo) Y = stem cell transplant

Question 27

Sporadic burkitt lymphoma associated with (X) disease. And endemic burkitt associated with (Y) disease.

Answer 27

``` X = HIV Y = Malaria and EBV ```

Question 28

Sporadic burkitt lymphoma associated with (X) location of mass. And endemic burkitt associated with (Y).

Answer 28

``` X = abdominal Y = jaw ```

Question 29

Breaking bad news: PULSE acronym

Answer 29

``` Privacy Understand (what pt knows, acknowledge feelings) Learn (what pt wants to know) Share (info; have pt repeat) Explicit planning and follow-up ```

Question 30

List some hematologic malignancies in which tumor lysis syndrome is a real treatment-induced complication.

Answer 30

1. ALL 2. Burkitt 3. (sometimes) AML and high tumor burden DLBCL

Question 31

Which agents are released in tumor lysis syndrome?

Answer 31

K, PO4, uric acid

Question 32

Rx for tumor lysis syndrome

Answer 32

1. Hydrate 2. Manage electrolytes (dialysis?) 3. Allopurinal or rasburicase 4. PO4 binders

Question 33

(ALL/AML): cytogenics determine prognosis.

Answer 33

Both

Question 34

Peripheral blood smear showing panmyeloid expansion with left shift (and lots of basophils) indicative of (X) (leukemia/lymphoma).

Answer 34

X = CML

Question 35

(CML/CLL) is diagnosed by flow cytometry.

Answer 35

CLL CML diagnosed by identifying t(9;22)

Question 36

A key prognostic factor in (CML/CLL) is deletion of (X) tumor suppressor. These patients tend to do (better/worse).

Answer 36

CLL X = p53 Worse

Question 37

List heme diseases in which autologous HCT is therapeutic, but not a cure.

Answer 37

MM and amyloidosis

Question 38

List heme malignancies in which autologous HCT is curative

Answer 38

Hodgkin and NHL

Question 39

HLA gene complex encodes (X) and found on chromosome (Y).

Answer 39

``` X = MHC proteins Y = 6(p21) ```

Question 40

What are the different graft sources for allogenic HCT? Star the current standard for most allogenic HCTs.

Answer 40

1. Peripheral blood* 2. Bone marrow 3. Umbilical cord

Question 41

T/F: Bone marrow graft for allogenic HCT has higher risk of failure than peripheral blood or umbilical cord grafts.

Answer 41

True

Question 42

Which graft source for allogenic HCT has a notable high risk for GVHD?

Answer 42

Peripheral blood

Question 43

Graft v Host Disease (GVHD): allorecognition of (host/donor) Ag by (host/donor) (X).

Answer 43

Host; Donor X = lymphocytes

Question 44

Acute Graft v Host Disease (GVHD): result is damage to which organs?

Answer 44

1. Skin (maculopapular rash) 2. Intestines (bloody diarrhea, N/V, anorexia) 3. Liver (bile canaliculi damage)

Question 45

Acute Graft v Host Disease (GVHD): occurs how many days post-transplant?

Answer 45

Within first 100 days

Question 46

Acute GVHD after transplant: how is liver damage graded?

Answer 46

Total BR level

Question 47

Acute GVHD after transplant: how is gut damage graded?

Answer 47

V of diarrhea

Question 48

Current backbone of GVHD prophylaxis:

Answer 48

1. Calcineurin inhibitor | 2. Methotrexate

Question 49

What's the single most important determinant of long-term outcome/quality of life after HCT?

Answer 49

Chronic GVHD

Question 50

T/F: Rates of acute and chronic GVHD have decreased over the years.

Answer 50

False - chronic GVHD incidence has remained constant

Question 51

List some skin findings you may expect in chronic GVHD.

Answer 51

1. Papular rash 2. Pigmentation changes 3. Sclerosis; joint contractures

Question 52

List some eye abnormalities you may find in chronic GVHD.

Answer 52

1. Inflammation/fibrosis of lacrimal gland (decreased tears) 2. Conjunctivitis/uveitis 3. Corneal ulceration

Question 53

List some GI issues you may find in chronic GVHD.

Answer 53

1. Esophageal dismotility/strictures 2. Chronic malabsorption, diarrhea 3. Liver issues (cholestatic)

Question 54

List some lung findings you may expect in chronic GVHD.

Answer 54

Bronchiolitis obliterans (intimal proliferation and fibrosis clog airways)

Question 55

Chronic GVHD 1st line therapy:

Answer 55

systemic corticosteroids

Question 56

List the three criteria that must be met for pt to reasonably be considered for stem cell transplant

Answer 56

1. Transplant has activity against disease in question 2. Risks/morbidities must be outweighed by benefit gained from transplant 3. Suitable donor

Question 57

T/F: Allogenic HCT transplant is more common in US than autologous HCT.

Answer 57

False - vice versa And rates of both have been steadily increasing

Question 58

Patient with DIC and constellation of immature WBCs containing auer rods makes you suspect (X) diagnosis. This can be confirmed by cytogenetics if (Y) is found.

Answer 58

``` X = APML Y = PML-RARa fusion protein ```