Clinical Approach for CLL, NHL and HL Flashcards Preview

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Flashcards in Clinical Approach for CLL, NHL and HL Deck (65)
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1
Q

Main Clinical characteristics for Hodgkin Lymphoma?

“PAIRR” of owl eyes for Hodgkin Lymphoma

A
PREDICTABLE Spread through Lymph vessels
ACCESSIBLE Lymphadenopathy
INFLAMMATORY background on Histo
RESPONDS to Treatment
REED-STERNBERG cells (Inflammatory "Owl eye" reactive cells)
2
Q

Why does Nodular Lymphocyte Predominant HL

considered NON-classic HL while Lymphocyte rich classical HL does?

A

POPCORN cells (altered RS )+different CDs

3
Q
4 types of Classic HL with Prognosis:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (Best)
Mixed Cellularity (Intermediate)
Lymphocyte Depleted (Poor)
Lymphocyte rich classical HL
A
4 types of Classic HL with Prognosis:
Nodular Sclerosing HL (Best)
Mixed Cellularity (Intermediate)
Lymphocyte Depleted (Poor)
Lymphocyte rich classical HL
4
Q
4 types of Classic HL with Prognosis:
Nodular Sclerosing HL (Best)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (Intermediate)
Lymphocyte Depleted (Poor)
Lymphocyte rich classical HL
A
4 types of Classic HL with Prognosis:
Nodular Sclerosing HL (Best)
Mixed Cellularity (Intermediate)
Lymphocyte Depleted (Poor)
Lymphocyte rich classical HL
5
Q
4 types of Classic HL with Prognosis:
Nodular Sclerosing HL (Best)
Mixed Cellularity (Intermediate)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (Poor)
Lymphocyte rich classical HL
A
4 types of Classic HL with Prognosis:
Nodular Sclerosing HL (Best)
Mixed Cellularity (Intermediate)
Lymphocyte Depleted (Poor)
Lymphocyte rich classical HL
6
Q
4 types of Classic HL with Prognosis:
Nodular Sclerosing HL (Best)
Mixed Cellularity (Intermediate)
Lymphocyte Depleted (Poor)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
A
4 types of Classic HL with Prognosis:
Nodular Sclerosing HL (Best)
Mixed Cellularity (Intermediate)
Lymphocyte Depleted (Poor)
Lymphocyte rich classical HL
7
Q

HL Ann Arbor Staging
1- __________________________
2- multiple LAD centers on one side of Diaphragm
3- LAD centers on two sides of Diaphragm
4- Extra lymphatic spread; Liver / Bone Marrow

A

HL Ann Arbor Staging
1- one LAD center on one side of Diaphragm
2- multiple LAD centers on one side of Diaphragm
3- LAD centers on two sides of Diaphragm
4- Extra lymphatic spread; Liver / Bone Marrow

8
Q

HL Ann Arbor Staging
1- one LAD center on one side of Diaphragm
2- ______________________________
3- LAD centers on two sides of Diaphragm
4- Extra lymphatic spread; Liver / Bone Marrow

A

HL Ann Arbor Staging
1- one LAD center on one side of Diaphragm
2- multiple LAD centers on one side of Diaphragm
3- LAD centers on two sides of Diaphragm
4- Extra lymphatic spread; Liver / Bone Marrow

9
Q

HL Ann Arbor Staging
1- one LAD center on one side of Diaphragm
2- multiple LAD centers on one side of Diaphragm
3- ____________________________
4- Extra lymphatic spread; Liver / Bone Marrow

A

HL Ann Arbor Staging
1- one LAD center on one side of Diaphragm
2- multiple LAD centers on one side of Diaphragm
3- LAD centers on two sides of Diaphragm
4- Extra lymphatic spread; Liver / Bone Marrow

10
Q

HL Ann Arbor Staging
1- one LAD center on one side of Diaphragm
2- multiple LAD centers on one side of Diaphragm
3- LAD centers on two sides of Diaphragm
4- _____________________________

A

HL Ann Arbor Staging
1- one LAD center on one side of Diaphragm
2- multiple LAD centers on one side of Diaphragm
3- LAD centers on two sides of Diaphragm
4- Extra lymphatic spread; Liver / Bone Marrow

11
Q

Initial Lymphadenopathy in HL is usually on (Location)

A

Initial Lymphadenopathy in HL is usually on Cervical Lymph nodes

12
Q

What is the possible complication of thoracic/mediastinal spread of HL?

A

Superior Vena Cava Syndrome (Bulky Disease)

13
Q

What is the name of the process Lymph nodes go through on HL?

A

Wax and Wane - Constant change in sizes

14
Q

Main Clinical characteristics for Non-Hodgkin Lymphoma?

“NUN” for Non-Hodgkin Lymphoma

A

NON-RESPONSIVE
UNPREDICTABLE skipping to distant LN
NON-ACCSSESIBLE Lymphadenopathy

15
Q

3 types of Classic NHL with Aggressiveness:
_______________ (Indolent)
Diffuse Large B cell Lymphoma (Aggressive )
Burkitt’s Lymphoma (Highly Aggressive PI 100%)

A

3 types of Classic NHL with Aggressiveness:
Follicular Lymphoma (Indolent)
Diffuse Large B cell Lymphoma (Aggressive )
Burkitt’s Lymphoma (Highly Aggressive PI 100%)

16
Q

3 types of Classic NHL with Aggressiveness:
Follicular Lymphoma (Indolent)
____________________ (Aggressive )
Burkitt’s Lymphoma (Highly Aggressive PI 100%)

A

3 types of Classic NHL with Aggressiveness:
Follicular Lymphoma (Indolent)
Diffuse Large B cell Lymphoma (Aggressive )
Burkitt’s Lymphoma (Highly Aggressive PI 100%)

17
Q

3 types of Classic NHL with Aggressiveness:
Follicular Lymphoma (Indolent)
Diffuse Large B cell Lymphoma (Aggressive )
___________________ (Highly Aggressive PI 100%)

A

3 types of Classic NHL with Aggressiveness:
Follicular Lymphoma (Indolent)
Diffuse Large B cell Lymphoma (Aggressive )
Burkitt’s Lymphoma (Highly Aggressive PI 100%)

18
Q

___________ Lymphoma is an indolent disease that is caused by t(18:14). It has good prognosis yet it is untreatable. If there’s another mutation on p53 it will transform to DLBL. It is the second most common NHL.

A

Follicular Lymphoma is an indolent disease that is caused by t(18:14). It has good prognosis yet it is untreatable. If there’s another mutation on p53 it will transform to DLBL. It is the second most common NHL.

19
Q

Follicular Lymphoma is an indolent disease that is caused by ______. It has good prognosis yet it is untreatable. If there’s another mutation on p53 it will transform to DLBL. It is the second most common NHL.

A

Follicular Lymphoma is an indolent disease that is caused by t(18:14). It has good prognosis yet it is untreatable. If there’s another mutation on p53 it will transform to DLBL. It is the second most common NHL.

20
Q

Follicular Lymphoma is an indolent disease that is caused by t(18:14). It has good prognosis yet it is __________. If there’s another mutation on p53 it will transform to DLBL. It is the second most common NHL.

A

Follicular Lymphoma is an indolent disease that is caused by t(18:14). It has good prognosis yet it is untreatable. If there’s another mutation on p53 it will transform to DLBL. It is the second most common NHL.

21
Q

Follicular Lymphoma is an indolent disease that is caused by t(18:14). It has good prognosis yet it is untreatable. If there’s another mutation on p53 it will transform to _____. It is the second most common NHL.

A

Follicular Lymphoma is an indolent disease that is caused by t(18:14). It has good prognosis yet it is untreatable. If there’s another mutation on p53 it will transform to DLBL. It is the second most common NHL.

22
Q

Follicular Lymphoma is an indolent disease that is caused by t(18:14). It has good prognosis yet it is untreatable. If there’s another mutation on p53 it will transform to DLBL. It is the _______ ____ common NHL.

A

Follicular Lymphoma is an indolent disease that is caused by t(18:14). It has good prognosis yet it is untreatable. If there’s another mutation on p53 it will transform to DLBL. It is the second most common NHL.

23
Q

________________ is the most common type of NHL. ~40% of patients will have B symptoms.
Although aggressive progress it is curable in 50% of cases depending on mutations. t(18:14) implies it is a transformed FL. Associated with EBV and HHV8.

A

Diffuse Large B cell Lymphoma is the most common type of NHL. ~40% of patients will have B symptoms.
Although aggressive progress it is curable in 50% of cases depending on mutations. t(18:14) implies it is a transformed FL. Associated with EBV and HHV8.

24
Q

Diffuse Large B cell Lymphoma is the most common type of NHL. ~40% of patients will have B symptoms.
Although aggressive progress it is curable in ___ of cases depending on mutations. t(18:14) implies it is a transformed FL. Associated with EBV and HHV8.

A

Diffuse Large B cell Lymphoma is the most common type of NHL. ~40% of patients will have B symptoms.
Although aggressive progress it is curable in 50% of cases depending on mutations. t(18:14) implies it is a transformed FL. Associated with EBV and HHV8.

25
Q

Diffuse Large B cell Lymphoma is the most common type of NHL. ~40% of patients will have B symptoms.
Although aggressive progress it is curable in 50% of cases depending on mutations. t(18:14) implies it is a transformed __. Associated with EBV and HHV8.

A

Diffuse Large B cell Lymphoma is the most common type of NHL. ~40% of patients will have B symptoms.
Although aggressive progress it is curable in 50% of cases depending on mutations. t(18:14) implies it is a transformed FL. Associated with EBV and HHV8.

26
Q

Diffuse Large B cell Lymphoma is the most common type of NHL. ~40% of patients will have B symptoms.
Although aggressive progress it is curable in 50% of cases depending on mutations. t(18:14) implies it is a transformed FL. Associated with EBV and _____.

A

Diffuse Large B cell Lymphoma is the most common type of NHL. ~40% of patients will have B symptoms.
Although aggressive progress it is curable in 50% of cases depending on mutations. t(18:14) implies it is a transformed FL. Associated with EBV and HHV8.

27
Q

Burkitt’s Lymphoma is that highest growth rate NHL. It is diagnosed by c-MYC mutation (t(_:14)). 80% is Endemic in African Children though it can be sporadic or Immunocompromise related. 80% cure rate if treated within 48hrs.

A

Burkitt’s Lymphoma is that highest growth rate NHL. It is diagnosed by c-MYC mutation (t(8:14)). 80% is Endemic in African Children though it can be sporadic or Immunocompromise related. 80% cure rate if treated within 48hrs.

28
Q

Burkitt’s Lymphoma is that highest growth rate NHL. It is diagnosed by c-MYC mutation (t(8:14)). _0% is Endemic in African Children though it can be sporadic or Immunocompromise related. 80% cure rate if treated within 48hrs.

A

Burkitt’s Lymphoma is that highest growth rate NHL. It is diagnosed by c-MYC mutation (t(8:14)). 80% is Endemic in African Children though it can be sporadic or Immunocompromise related. 80% cure rate if treated within 48hrs.

29
Q

Burkitt’s Lymphoma is that highest growth rate NHL. It is diagnosed by c-MYC mutation (t(8:14)). 80% is Endemic in African Children though it can be sporadic or Immunocompromise related. _0% cure rate if treated within 48hrs.

A

Burkitt’s Lymphoma is that highest growth rate NHL. It is diagnosed by c-MYC mutation (t(8:14)). 80% is Endemic in African Children though it can be sporadic or Immunocompromise related. 80% cure rate if treated within 48hrs.

30
Q

Burkitt’s Lymphoma is that highest growth rate NHL. It is diagnosed by c-MYC mutation (t(8:14)). 80% is Endemic in African Children though it can be sporadic or Immunocompromise related. 80% cure rate if treated within 4_hrs.

A

Burkitt’s Lymphoma is that highest growth rate NHL. It is diagnosed by c-MYC mutation (t(8:14)). 80% is Endemic in African Children though it can be sporadic or Immunocompromise related. 80% cure rate if treated within 48hrs.

31
Q
Major indicators of NHL Poor Prognosis:
Elevated \_\_\_ (from TLS)
Age (above 60)
ECOG >2 (Chemotherapy Damage)
Ann arbor>2
Sites of Extranidal Involvement>1
A
Major indicators of NHL Poor Prognosis:
Elevated LDH (from TLS)
Age (above 60)
ECOG >2 (Chemotherapy Damage)
Ann arbor>2
Sites of Extranidal Involvement>1
32
Q
Major indicators of NHL Poor Prognosis:
Elevated LDH (from TLS)
\_\_\_(above 60)
ECOG >2 (Chemotherapy Damage)
Ann arbor>2
Sites of Extranidal Involvement>1
A
Major indicators of NHL Poor Prognosis:
Elevated LDH (from TLS)
Age (above 60)
ECOG >2 (Chemotherapy Damage)
Ann arbor>2
Sites of Extranidal Involvement>1
33
Q
Major indicators of NHL Poor Prognosis:
Elevated LDH (from TLS)
Age (above 60)
\_\_\_\_ >2 
Ann arbor>2 
Sites of Extranidal Involvement>1
A
Major indicators of NHL Poor Prognosis:
Elevated LDH (from TLS)
Age (above 60)
ECOG >2 (Chemotherapy Damage)
Ann arbor>2
Sites of Extranidal Involvement>1
34
Q
Major indicators of NHL Poor Prognosis:
Elevated LDH (from TLS)
Age (above 60)
ECOG >2 (Chemotherapy Damage)
\_\_\_\_\_ \_\_\_\_>2 
Sites of Extranidal Involvement>1
A
Major indicators of NHL Poor Prognosis:
Elevated LDH (from TLS)
Age (above 60)
ECOG >2 (Chemotherapy Damage)
Ann arbor>2 (Both sides of Diaphragm)
Sites of Extranidal Involvement>1
35
Q
Major indicators of NHL Poor Prognosis:
Elevated LDH (from TLS)
Age (above 60)
ECOG >2 (Chemotherapy Damage)
Ann arbor>2
Sites of \_\_\_\_\_\_\_\_ Involvement>1
A
Major indicators of NHL Poor Prognosis:
Elevated LDH (from TLS)
Age (above 60)
ECOG >2 (Chemotherapy Damage)
Ann arbor>2
Sites of Extranidal Involvement>1
36
Q

Common treatment in HL:
Anti-___
Anti-CD30
HSC Transplantation

A

Common treatment in HL:
Anti-PD1 = Pembrolizumab (Keytruda)
Anti-CD30
HSC Transplantation

37
Q

Common treatment in HL:
Anti-PD1
Anti-CD__

A

Common treatment in HL:
Anti-PD1
Anti-CD30 = Brentuximab vedotin

38
Q

What secondary Hematological HL treatment complication are unique to HL?

A

Secondary Myelodysplastic Syndromes or Leukemias

39
Q
Common treatment in NHL: "R-CHOP"
(Anti-CD20?)
Cyclophosphamide
Hydroxydaunorubicin
Oncovin (Vincristine)
Prednisone
A
Common treatment in NHL: "R-CHOP"
Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Oncovin (Vincristine)
Prednisone
40
Q
Common treatment in NHL: "R-CHOP"
Rituximab
(Alkylating Agent?)
Hydroxydaunorubicin
Oncovin (Vincristine)
Prednisone
A
Common treatment in NHL: "R-CHOP"
Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Oncovin (Vincristine)
Prednisone
41
Q
Common treatment in NHL: "R-CHOP"
Rituximab
Cyclophosphamide
(Antibiotic type chemo?)
Oncovin (Vincristine)
Prednisone
A
Common treatment in NHL: "R-CHOP"
Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Oncovin (Vincristine)
Prednisone
42
Q
Common treatment in NHL: "R-CHOP"
Rituximab
Cyclophosphamide
Hydroxydaunorubicin
(Anti-Microtubule?)
Prednisone
A
Common treatment in NHL: "R-CHOP"
Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Oncovin (Vincristine)
Prednisone
43
Q
Common treatment in NHL: "R-CHOP"
Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Oncovin (Vincristine)
(Immunosuppressant?)
A
Common treatment in NHL: "R-CHOP"
Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Oncovin (Vincristine)
Prednisone
44
Q

What is a mandatory localized, accessory (to pharmacological intervention) treatment in each of the lymphomas?

A

Radiotherapy

45
Q

CLL is the most common leukemia in the ____, it occurs mostly in adult males.

A

CLL is the most common leukemia in the west, it occurs mostly in adult males.

46
Q

CLL is the most common leukemia in the west, it occurs mostly in adult ____.

A

CLL is the most common leukemia in the west, it occurs mostly in adult males.

47
Q

Diagnosis of CLL is made by two separate measurements (6 months apart) of over _ x 10^9/L CDD23/CD5+ lymphocytes that is confirmed by presence in bone marrow biopsy.

A

Diagnosis of CLL is made by two separate measurements (6 months apart) of over 5 x 10^9/L CDD23/CD5+ lymphocytes that is confirmed by presence in bone marrow biopsy.

48
Q

Diagnosis of CLL is made by two separate measurements (_ months apart) of over 5 x 10^9/L CDD23/CD5+ lymphocytes that is confirmed by presence in bone marrow biopsy.

A

Diagnosis of CLL is made by two separate measurements (6 months apart) of over 5 x 10^9/L CDD23/CD5+ lymphocytes that is confirmed by presence in bone marrow biopsy.

49
Q

Diagnosis of CLL is made by two separate measurements (6 months apart) of over 5 x 10^9/L CD__/CD5+ lymphocytes that is confirmed by presence in bone marrow biopsy.

A

Diagnosis of CLL is made by two separate measurements (6 months apart) of over 5 x 10^9/L CDD23/CD5+ lymphocytes that is confirmed by presence in bone marrow biopsy.

50
Q

What cells are present on peripheral blood smear of CLL ?

A

Smudge cells (aka basket cells)

51
Q

CLL that presents with the proteins CD__ or ZAP70 have poor prognosis.

A

CLL that presents with the proteins CD38 or ZAP70 have poor prognosis.

52
Q

CLL that presents with the proteins CD38 or ZAP__ have poor prognosis.

A

CLL that presents with the proteins CD38 or ZAP70 have poor prognosis.

53
Q

Poor prognosis indicators on Cytology of CLL: -1_p and -11q.
“Primal Numbers on 10-20”

A

Poor prognosis indicators on Cytology of CLL: -17p and -11q.
“Primal Numbers on 10-20”

54
Q

Poor prognosis indicators on Cytology of CLL: -17p and -1_q.
“Primal Numbers on 10-20”

A

Poor prognosis indicators on Cytology of CLL: -17p and -11q.
“Primal Numbers on 10-20”

55
Q

Good prognosis indicators on Cytology of CLL: -1_q

“Primal Numbers on 10-20”

A

Good prognosis indicators on Cytology of CLL: -13q

“Primal Numbers on 10-20”

56
Q

What are the hematological complications of CLL?

“AIR”

A

AIHA
ITP
RICHTER transformation (to DLBL)

57
Q

Rai Staging for CLL:
0: _________ Alone
I: Lymphocytosis + Lymphadenopathy
II: Lymphocytosis + Lymphadenopathy +Splenomegaly
III: Lymphocytosis + Any case of Anemia (Hb < 11)
IV: Lymphocytosis + Any case of Thrombocytopenia

A

Rai Staging for CLL:
0: Lymphocytosis Alone
I: Lymphocytosis + Lymphadenopathy
II: Lymphocytosis + Lymphadenopathy +Splenomegaly
III: Lymphocytosis + Any case of Anemia (Hb < 11)
IV: Lymphocytosis + Any case of Thrombocytopenia

58
Q

Rai Staging for CLL:
0: Lymphocytosis Alone
I: Lymphocytosis + _____________
II: Lymphocytosis + Lymphadenopathy +Splenomegaly
III: Lymphocytosis + Any case of Anemia (Hb < 11)
IV: Lymphocytosis + Any case of Thrombocytopenia

A

Rai Staging for CLL:
0: Lymphocytosis Alone
I: Lymphocytosis + Lymphadenopathy
II: Lymphocytosis + Lymphadenopathy +Splenomegaly
III: Lymphocytosis + Any case of Anemia (Hb < 11)
IV: Lymphocytosis + Any case of Thrombocytopenia

59
Q

Rai Staging for CLL:
0: Lymphocytosis Alone
I: Lymphocytosis + Lymphadenopathy
II: Lymphocytosis + Lymphadenopathy +_________
III: Lymphocytosis + Any case of Anemia (Hb < 11)
IV: Lymphocytosis + Any case of Thrombocytopenia

A

Rai Staging for CLL:
0: Lymphocytosis Alone
I: Lymphocytosis + Lymphadenopathy
II: Lymphocytosis + Lymphadenopathy +Splenomegaly
III: Lymphocytosis + Any case of Anemia (Hb < 11)
IV: Lymphocytosis + Any case of Thrombocytopenia

60
Q

Rai Staging for CLL:
0: Lymphocytosis Alone
I: Lymphocytosis + Lymphadenopathy
II: Lymphocytosis + Lymphadenopathy +Splenomegaly
III: Lymphocytosis + Any case of _____
IV: Lymphocytosis + Any case of Thrombocytopenia

A

Rai Staging for CLL:
0: Lymphocytosis Alone
I: Lymphocytosis + Lymphadenopathy
II: Lymphocytosis + Lymphadenopathy +Splenomegaly
III: Lymphocytosis + Any case of Anemia (Hb < 11)
IV: Lymphocytosis + Any case of Thrombocytopenia

61
Q

Rai Staging for CLL:
0: Lymphocytosis Alone
I: Lymphocytosis + Lymphadenopathy
II: Lymphocytosis + Lymphadenopathy +Splenomegaly
III: Lymphocytosis + Any case of Anemia (Hb < 11)
IV: Lymphocytosis + Any case of ______________

A

Rai Staging for CLL:
0: Lymphocytosis Alone
I: Lymphocytosis + Lymphadenopathy
II: Lymphocytosis + Lymphadenopathy +Splenomegaly
III: Lymphocytosis + Any case of Anemia (Hb < 11)
IV: Lymphocytosis + Any case of Thrombocytopenia (Plt < 150K)

62
Q

What are the patients that should be started on treatment in CLL?

A

Rai Staging > II

Binet Staging > C

63
Q

(Purine Analogue?) and Chlorambucil/Bendamustine are common drugs that are involved in treatment of CLL.

A

Fludarabine and Chlorambucil/Bendamustine are common drugs that are involved in treatment of CLL.

64
Q

Fludarabine and (Alkylating Agent?) are common drugs that are involved in treatment of CLL.

A

Fludarabine and Chlorambucil/Bendamustine are common drugs that are involved in treatment of CLL.

65
Q

(Anti-52?) is used less than Rituximab in treatment of CLL, due to it’s more robust immunosuppression.

A

Alemtuzumab is used less than Rituximab in treatment of CLL, due to it’s more robust immunosuppression.