Hemeonc 14

Question 1

what is Cancer of the lymph nodes?

Answer 1

lymphoma

Question 2

What classifications of lymphoma should you know?

Answer 2

Hodgkin’s/Non
Mature B cell neoplasms (common, easier to tx)
over 70 types

Question 3

When you do a physical exam of the lymph nodes, what findings would raise a red flag for lymphoma?

Answer 3

enlarged, non tender rubbery lymph node(s). Nodes that are “fixed” in location.

Question 4

In addition to your physical exam, what symptoms might raise a red flag for lymphoma

Answer 4

persistant “idiopathic” cough, severe night sweats, pruritus (after showering)

Question 5

What cells express CD15 and CD30(hallmark of Hodgkin’s)?

Answer 5

Reed-Sternberg cells (owl eyes)

Question 6

How is a definitive dx of lymphoma made?

Answer 6

EXCISIONAL bx (to see specific cell markers that cannot be seen with aspiration bx)

Question 7

In Ann Arbor staging of lymphoma, describe the 4 stages (called “cotswold’s staging” in handout)

Answer 7

I–single lymph node region
II–2+ lymph node regions on the SAME side of the diaphragm
III–lymph node regions on BOTH sides of the diaphragm
IV–diffuse involvement of an organ or tissue (other than lymph)

Question 8

what are “B symptoms”

Answer 8

constitutional: fever, night sweats, wt loss

Question 9

what is the preferred treatment of early stage Hodgkin’s lymphoma (stage I-II)

Answer 9

Favorable:
2-4 cycles of ABVD chemo + radiation OR
6 cycles of ABVD chemo

Unfavorable:
ABVD chemo until max tumor response + 2 cycles and radiation

Question 10

what is the preferred tx of advanced stage Hodgkin’s lymphoma (stage III-IV)

Answer 10

ABVD chemo x 6 +/- radiation (radiation not supported by research, but many clinicians will use)

Question 11

What time frame constitutes and early relapse vs a late relapse?

Answer 11

Early 12 months

Question 12

What is a new, well tolerated second line chemo that we were asked to remember?

Answer 12

Brentuximab

Question 13

If you had a patient with an early relapse of Hodgkin’s lymphoma, what would you recommend? Late relapse

Answer 13

Early = chemo + autologous transplant
Late = chemo +/- radiation

Allogenic transplant is last resort in rare cases
(NOTE: autologous transplant is not an option for aggressive lymphomas)

Question 14

What is a risk factor for non-HL

Answer 14

h/o immunosuppression/auto immune dz

Question 15

On lab tests for lymphomas, what would you expect LDH to do?

Answer 15

elevation (due to high cell turnover rates)

Question 16

What is significant about Burkett’s lymphoma? What would the PBS look like?

Answer 16

Burkett’s is very aggressive. PBS looks like a “starry sky”

Question 17

Should you be really sad, if you find a very aggressive non-HL?

Answer 17

Not necessarily, more aggressive = more treatable

Question 18

When staging non-HL, what might you want to perform?

Answer 18

BMbx (always, presence of CA will be stage IV)
PET scan, eval for B symptoms
LP/brain MRI (if CNS involvement suspected)

Question 19

what drug is an anti B cell treatment?

Answer 19

Rituximab

Question 20

Autologous and Allogenic transplants are options after relapse of what lymphoma?

Answer 20

Large B cell (and early relapse Hodgkin’s)

Question 21

t-cell and natural killer cell lymphomas have a poor prognosis, true or false?

Answer 21

true

Question 22

When should you consider transplant for lymphomas?

Answer 22

only in a relapse setting