Week 4: Case studies of leukemia/lymphoma

Question 1

What are the “B symptoms” of Hodgkin’s Lymphoma?

Answer 1

Fever, >10% weight loss, neigh sweats

Question 2

What should you counsel on with a reproductive-age male before giving chemo therapy?

Answer 2

Fertility counseling

Question 3

Why is an excisional biopsy needed for HL diagnosis on not just a fine-needle aspirate?

Answer 3

need to see the architecture

Question 4

T/F: Hodgkin is not an HIV-related malignancy

Answer 4

False, highly related to HIV

Question 5

Do males or females get HL?

Answer 5

More males than females

Question 6

What is the malignant cell of HL?

Answer 6

Reed-Sternberg cell (B-cell)

Question 7

Does HL jump randomly from lymph node to lymph node?

Answer 7

No, spreads contiguously

Question 8

What is the standard of care of HL?

Answer 8

ABVD: Adriamycin, bleomycin, vinblastine, dacarbazine. Rituximab is a new treatment

Question 9

What are the “classical” HL presentations? What are the classic markers present on these cells?

Answer 9

Nodular sclerosis, lymphocyte-rich, mixed cellularity, lymphocyte depleted; CD15, CD30

Question 10

What marker is typically found on nodular lymphocyte predominant HL?

Answer 10

CD20 (can be targeted by rituximab)

Question 11

What is the staging for lymphomas?

Answer 11

Ann Arbor staging:
I: Single LN region
II: One side of diaphragm
III: Both side of diaphragm
IV: disseminated throughout body
A: no systemic symptoms
B: fever, night sweats, weight loss

Question 12

What is the treatment for Stages I and II of HL?

Answer 12

ABVD x 2, involved field radiation

Question 13

What is the treatment for stages 3 and 4 HL?

Answer 13

ABVD x 2, restage the disease, if it’s ok treat with ABVD x4, if refractory switch to BEACOPP and autologous transplant

Question 14

What are late effects of HL therapy?

Answer 14

second malignancy (Lung and breast), heart disease because of drugs, lung disease, impaired fertility

Question 15

What labs can you order to look at cell turn over rate?

Answer 15

LDH and uric acid

Question 16

What are prognostic factors of the IPI scoring system?

Answer 16

Age over 60, Stage III/IV, spending more than 1/2 day resting, elevated LDH, two ore more extranodal sites

Question 17

What is treatment of non-hodgkin lymphoma?

Answer 17

R-CHOP (rituximab, adriamycin, cyclophosphamide, vincrstine, prednisone)

Question 18

What are clinical pearls of Diffuse Large B-cell lympoma?

Answer 18

most aggressive NHL in adults and most common, quickly fatal if not treated, usually CD20+, so treat with rituxiab

Question 19

t(14;18) is most common in which NHL? What’s the result?

Answer 19

Follicular lymphoma, Bcl-2 translocated to avoid apoptosis

Question 20

t(11;14) is most common in which NHL? What’s the result?

Answer 20

Mantle cell lymphoma, increase in Cyclin D1

Question 21

What is usually the cause of MALT lymphoma?

Answer 21

H. pylori infection

Question 22

Can immune suppression lead to lymphoproliferative disorders? How do you treat it?

Answer 22

Yes it can lead to B cell proliferation because of T cell suppression, back off immune suppression