Lymphoma Cases & Review - Kebbekus Flashcards

1
Q

What is important to examine when thinking about a lymphoma diagnosis?

A
  • Physical exam
    • check all lymph node chains
  • B symptoms
    • Weight loss (>10%)
    • Drenching night sweats
    • Fever (don’t make sense)
  • CBC with differential
  • Metabolic panel
  • LDH
  • HIV testing
  • Uric acid (purines from killed cells)
    • prevent kidney disease
  • Excisional biopsy
    • If cancer is the issue, tissue is the answer
    • Bone marrow
    • Flow cytometry
  • Staging imaging (CT/PET)
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2
Q

What characterizes Hodgkin’s Lymphoma?

A
  • Malignant cell = Reed-Sternberg cell
  • Now recognized as a B-cell origin
    • some are CD20+
  • Bulk of the tumor is reactive tissue
  • Spreads contiguously from node to node
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3
Q

What are the symptoms of Hodgkins’ Lymphoma?

A
  • Enlarging, rubbery, but not tender lymphadenopathy
    • typically in neck or chest
  • Accompanied by:
    • fatigue
    • feverB
    • weight lossB
    • night sweatsB
    • Pain with EtOH
    • Symptoms of cytopenias
    • Hepatosplenomegaly
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4
Q

How common is Hodgkin’s Lymphoma?

A
  • Rare cancer
  • Common in young people with cancer
    • 1 in 5 types of cancer for young people
  • <4 people in 100,000 overall
  • Slight male predominance (5:4 men:women)
  • HIV related malignancy
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5
Q

What is the best chemotherapy treatment for Hodgkin’s Lymphoma?

A
  • ABVD
    • Adriamycin (cardiotoxicity)
    • Bleomycin (lung toxicity)
    • Vinblastine (numbess)
    • Dacarbazine
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6
Q

What are the stages of Lymphomas?

A
  • Ann Arbor Staging
    • I: single lymph node region
    • II: One side of diaphragm
    • III: Both sides of diaphragm
    • IV: Disseminated
      • effusions
      • liver & spleen
      • bone marrow
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7
Q

How is localized favorable risk HL disease treated with the intent to cure?

A
  • ABVD x2 (restage)
  • Involved field radiation
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8
Q

How is Stage III/IV HL Disease treated?

A
  • ABVD
  • BEACOPP
  • Autologous transplant
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9
Q

What are the late effects of chemotherapy in HL?

A
  • Second malignancy
  • Heart disease (MI, CAD)
  • Lung disease
  • Impaired fertility
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10
Q

What markers do you look for in Lymphoma?

A
  • CD5-
  • CD19+
  • CD20+
  • CD23-
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11
Q

What sytem do you use to classify Non-Hodgkin’s Lymphoma?

A
  • IPI Scoring System
    • score 0-5
    • 0-1 = cure
    • 2 = cure most
    • 3-5 = cure about half
  • Prognostic factor:
    • Age over 60
    • Stage III/IV
    • ECOG PS 3 or 4 (more than ½ day resting)
      • level of physical health
    • Elevated LDH
    • Two or more extranodal sites
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12
Q

What characterizes Diffuse Large B-cell Lymphoma?

Treatment?

A
  • Prototype aggressive NHL
  • Accounts for 40% of lymphomas
  • Average age of onset is 67
  • 75.3% of cases are above the age of 55
  • If left untreated it is quickly fatal
  • Treated with CHOP (more intense regimens have not been shown to improve overall survival, 1993)
  • The addition of rituximab (anti-CD20) in 1997 was a difference maker: R-CHOP
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13
Q

What translocation is associated with Follicular Lymphoma?

A

t(14;18)

  • Bcl-2 is translocated to chromosome 14
  • comes under control of IgH enhancer which leads to overexpression of BCL-2
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14
Q

Is follicular lymphoma cureable?

A
  • Typically (over 80%!) advanced stage at presentation
  • Often asymptomatic
  • FL not curable with chemotherapy
  • Most common indolent NHL
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15
Q

What is the survival rate in Follicular Lymphoma?

A
  • Stage I-II
    • 50% long term (10-20 yrs) disease free survival with radiotherapy alone (?cure?)
  • ​Stage III-IV
    • Remission rate
    • 70-85% with chemo
    • 50-70% with rituximab
    • 70-90% with chemo + rituximab
  • Cure rate 0%
  • Median survival 10-12 years, longer in younger pts
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16
Q

What kind of lymphoma expresses cyclinD1?

A

Mantle Cell Lymphoma

17
Q

What is MALT Lymphoma associated with?

A
  • H. pylori
    • eradicate infection first (often cures MALT Lymphoma)
18
Q

What are there so many types of lymphomas?

A

Maturation is so goddamn complicated!

19
Q

What type of lymphoma doe solid organ transplant patients get?

A
  • Post-transplant Lymphoproliferative Disorder
    • poly-clonal, expansion of B-cells
    • The suppression of T-cells (immunosuppressives to prevent organ rejection) leads to a loss of suppression of B-cell proliferation
20
Q

What are the general principles of T-cell lymphomas?

A
  • Not curable
  • Frequently relapse, but systemic involvement is uncommon
  • Treatment is UV light, radiation, topical or systemic
  • CHOP is first line treatment
    • If CD 30+, then brentuximab vedotin as targeted therapy