Exam 3 - Lymphoma

Question 1

List risk factors for lymphomas? (8)

Answer 1

male gender, older age (younger as well in HL), immunosuppression, infections, environmental exposures, radiation exposure, Epstein-Barr virus, HIV infection

Question 2

Describe the epidemiology of non-Hodgkin’s lymphoma (NHL)?

Answer 2

occurs more frequently in European descent, B-cells most common

Question 3

List signs/symptoms of diffuse large B-cell lymphomas (DLBCL)?

Answer 3

B-symptoms (fever, night sweats, significant weight loss as 10% in 6 months), nodal masses, elevated lactate dehydrogenase, bone marrow involvement, AMS

Question 4

Which mutation is most important in diagnosing NHL?

Answer 4

CD20

Question 5

What is preferred treatment for NHL? (2)

Answer 5

R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), Pola-R-CHP (polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, prednisone)

Question 6

What are chemotherapy considerations for CHOP and ABVD therapies? (2)

Answer 6

high emetic risk (give anti-emetic regimen prior) and consider G-CSFs in high risk patients (febrile neutropenia prevention)

Question 7

What are AEs of CHOP therapy?

Answer 7

infections, fatigue, anemia, alopecia

Question 8

What is the maximum lifetime anthracycline dose?

Answer 8

450-500 mg/m^2

Question 9

What are AEs of vincristine? (2)

Answer 9

peripheral neuropathy (max 2 mg dose), constipation

Question 10

What is an AE of cyclophosphamide?

Answer 10

hemorrhagic cystitis

Question 11

What is the MoA of rituximab?

Answer 11

anti-CD20 moAb

Question 12

What are AEs of rituximab? (4)

Answer 12

infusion-related reactions, hepB reactivation, hypogammaglobulinemia (GI perforations), PML

Question 13

Explain what antibodies are present in acute/chronic HBV infection?

Answer 13

positive HBsAg, positive anti-HBc, positive/negative anti-HBc, negative antiHBs

Question 14

What is another treatment for NHL?

Answer 14

DA-R-EPOCH (dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin)

Question 15

When is a DA-R-EPOCH regimen the treatment of choice? What MUST be given following it?

Answer 15

double- or triple-hit B-cell lymphomas; G-CSF

Question 16

What is the MoA of polatuzumab vedotin (Polivy)?

Answer 16

anti-CD79B conjugated to microtubule disruptor

Question 17

What are AEs of polatuzumab vedotin (Polivy)? (5)

Answer 17

myal/arthralgia, constipation, peripheral neuropathy, infusion-related reactions, anemias

Question 18

List relapse/refractory treatments for NHL? (4)

Answer 18

R-ICE (rituximab, ifosamide, carboplatin, etoposide) and GDP (gemcitabine, dexamethasone, carboplatin), autologous stem cell transplant, CAR-T, bispecific moAbs

Question 19

What is fixed-duration treatment for normal TP53* CLL/SLL?

Answer 19

venetoclax + obinutuzumab

Question 20

What is indefinite treatment for normal TP53* CLL/SLL?

Answer 20

acalabrutinib +/- obinutuzumab or zanubrutinib or ibrutinib

Question 21

What is indefinite treatment for mutated TP53* CLL/SLL?

Answer 21

acalabrutinib +/- obinutuzumab or zanubrutinib or ibrutinib

Question 22

What is fixed duration treatment for mutated TP53* CLL/SLL?

Answer 22

venetoclax + obinutuzumab

Question 23

What is the MoA of obinutizimab (Grazyva)?

Answer 23

anti-CD20 moAb (2nd gen)

Question 24

What are AEs of obinutuzumab (Gazyva)? (3)

Answer 24

infusion-related reactions, hepB reactivation, increased viral infection risk

Question 25

What is the MoA of Bruton tyrosine kinase inhibitors?

Answer 25

block B-cell receptor signaling cascade and prevent proliferation and survival of all B-cells

Question 26

What is the first generation BTKi? Second? (2)

Answer 26

ibrutinib (Imbruvica); acalbrutinib (Calquence), zanubrutinib (Brukinsa)

Question 27

What are AEs more associated with the first generation BTKi (ibrutinib)?

Answer 27

atrial fibrillation, bleeding events, diarrhea, HTN

Question 28

List signs/symptoms of Hodgkin's lymphomas (HL)?

Answer 28

B-symptoms (fever, night sweats, weight loss), lymphadenopathy, generalized malaise

Question 29

What is treatment for Stage I/II HL?

Answer 29

ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)

Question 30

What is treatment for Stage III/IV HL? (3)

Answer 30

ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), BV+AVD (brentuximab vedotin with AVD), escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone)

Question 31

What is an AE of bleomycin?

Answer 31

pulmonary toxicity

Question 32

What is an AE of dacarbazine?

Answer 32

cytopenias

Question 33

What is the MoA of brentuximab vedotin (Adcetris)?

Answer 33

anti-CD30 conjugated to microtubule disruptor

Question 34

What are AEs of brentuximab vedotin (Adcetris)? (5)

Answer 34

pulmonary toxicity, constipation, peripheral neuropathy, infusion-related reactions, anemias

Question 35

List relapse/refractory treatments for HL? (3)

Answer 35

R-ICE (rituximab, ifosamide, carboplatin, etoposide) and GVD (gemcitabine, vinorelbine, liposomal doxorubicin), autologous stem cell transplant, immunotherapy (nivolumab, pembrolizumab)