Lymphoma Flashcards
(11 cards)
Histology shows nodular collections of small lymphocytes and histiocytes with scattered mononuclear cells, with convoluted irregular nuclei and occasional small nucleoli. By immunohistochemistry these cells are positive for CD19, CD20, CD79a, CD45, and BCL-6 but are negative for CD15, CD30, and EBV markers.
The malignant cells of NLPHL are LP cells show a phenotype consistent with germinal center B cells.
IHC positive for CD20, CD45, CD79a, PAX5, and BCL-6 but negative for CD10, CD15, and CD30.
They also will express RNA transcription factors octamer-binding transcription factor 2 (Oct-2) and B-cell Oct-binding protein 1 (BOB.1).
A 17-year-old is diagnosed with advanced stage anaplastic large cell lymphoma involving skin and lymph nodes in the neck, axilla and mediastinum. Based on the immunophenotype of ALK+ ALCL, what is an appropriate targeted therapy to include in initial therapy for this patient?
A CD30-directed antibody-drug conjugate such as brentuximab vedotin
When do you use radiation in lymphoma?
The use of low-dose involved field radiation is a routine component of treatment for pediatric patients with high-risk Hodgkin lymphoma who do not obtain a complete metabolic remission following chemotherapy.
e.g:
Involved node radiation to a Deauville 4 (with uptake markedly increased compared with the liver) PET-avid residual tumor mass after chemotherapy for a patient with stage IIIB bulky nodular sclerosing Hodgkin lymphoma
How to treat early relapsed HL?
. The standard of care for this type of patients is remission reinduction followed by consolidation with high-dose chemotherapy and autologous stem cell transplant (ASCT).
CD-30 directed chemoimmunotherapy such as the antibody-drug conjugate brentuximab vedotin. This agent is one of the most active agents in the relapse setting and should be included.
Define early relapse HL ?
early relapse of Hodgkin lymphoma, defined as relapse between 3 months and 12 months following completion of therapy
Define B symptoms?
B symptoms include: (a) fever >38°C for at least 3 consecutive days, (b) >10% unexplained weight loss over the preceding 6 months, and (c) drenching night sweats (usually requiring changing of clothing and/or bedding).ho
Lymphomas localized to the ileocecal region
Lymphomas localized to the ileocecal region in children are almost always Burkitt (or Burkitt-like) .
Sporadic Burkitt lymphoma commonly presents as an abdominal mass is boys 5 to 10 years of age.
An ileocecal intussusception is present in up to 30% of patients and the resulting pain or mass in the right lower quadrant can be confused with acute appendicitis. Of note, surgical resection of intussuscepted bowel can result in early detection of cancer; these patients can often be cured with minimal chemotherapy
Relapsed HL after Bv-AVE-PC what is next ?
checkpoint inhibitor should absolutely be strongly considered as PART of a salvage regimen. Checkpoint inhibitors such as nivolumab or pembrolizumab are monoclonal antibodies which target the PD-L1, PD-1 pathway and reverses the immunoinhibitory signals within the Hodgkin lymphoma tumor microenvironment which is responsible for inducing T cell anergy and decreased T cell effector function. By reversing these immunosuppressive interactions, checkpoint inhibitors restore anti-tumor immunity.
Male versus female fertality in HL tx
Compared with female fertility, male fertility is much more sensitive to alkylating agents, and therefore gender-based therapies have been developed for Hodgkin lymphoma. An example of this is the substitution of etoposide for procarbazine for male patients.
hematolymphoid neoplasm that expresses CD30 and evidence of T cell receptor rearrangement but lacks TdT expression
anaplastic large cell lymphoma (ALCL), a mature T cell lymphoma. The majority of ALCL are characterized by the t(2;5)(p23;q35) chromosomal translocation and NPM-ALK fusion gene. The NPM gene promoter results in overexpression of the ALK kinase in lymphoid cells.
The clue is that there is T cell recepetor rearrangment! !
Pediatric DLBCL can express high levels of ** and ***
Pediatric DLBCL can express high levels of BCL-6 as well as CD10.
