What 4 major factors must a doctor consider when he/she decides if cure is possible for a patient with lymphoma?
Condition of patient
Name the most common indolent lymphoma. Aggressive lymphoma?
Indolent: Follicular lymhoma
Aggressive: Diffuse Large B cell lymphoma
Very Aggressive: Burkitt's (t(8;14))
Be able to stage a patient with lymphoma
-Stage I: single node or lymphoid structure
--Stage IE: extranodal is the sole site of involvment
-Stage II: Two or more lymph regions one side diaphragm
-Stage III: both sides of diaphragm
Stage IV: Lymph node involvement plus an extranodal site of involvement
How to stage: history and exam, CAT scan chest, abdomen and pelvis, BM aspirate and biopsy w/ flow, Gallium or PET scan, Chemistries: CBC, LDH and CSF is high risk disease
What are the major treatment decision differences between indolent and aggressive lymphomas?
Indolent: (1) Higher stage (2) Slower progression (3) Response to simple therapies (4) incurable except with stage 1-2 (allogenic transplant may cure) (5) survival independent of early treatment (6) treat when symptomatic
Aggressive: (1) often lower stage (2) rapid progression (3) requires complex therpies (4) potential cure** (5) early therapy required, treat right away
Understand the mechanism and sites of action of rituximab and ibrutinib.
Rituximab: CD20: increased survival when added to CHOP
Ibrutinib: Bruton Tyrosine Kinase Inhibitior (Bcell Refractory disease)
-Prevents Kinase to eventual activation of NFkB which will induce transcription of survival signals to avoid apoptosis
Other drugs mentioned:
Alemtuzumab (CD52, CLL and T-cell leukemia)
Brentuximab vedatin: CD30 (Hodgkin and CD30+ T cell lymphomas)
Inotuzumab ozogamicin: CD22
What is the name of the most common cutaneous lymphoma and what cell can you find in the blood in some of these patients?
-T cell derived (usually indolent)
Stage 4: seizry syndrome
What is a common complication of radiation therapy in young Hodgkin’s Disease women?
-They are at an increased risk for breast cancer w/n 30yrs of treatment, some showing up as early as 15 yrs
-Reconsidering chemo therapy for these patient
Name two complications of CLL.
-Hypogammaglobulinemia: reoccuring infections
Name two poor prognostic chromosome abnormalities in CLL.
-Increased lymphocyte doubling time
-Deletion 17p, 11q23 (p53)
-Unmutated VH gene, ZAP-70, CD38
When is BMT used in Lymphomas?
-Indolent lymphomas that are stage I or II
-Aggressive lymphomas that relapse