lymphoma

Question 1

what is the epidemiology of Chronic Lymhocytic Leukemia (CLL)

Answer 1

dz of older age median age of 72 y.o

Question 2

what would be the absolute lymphocyte count be in CLL

Answer 2

5,000 mm and these lymphocytes are small B cells
+CD19, 20, 23 (B cell Ags)
as well as being + for the T cell Ag CD5

Question 3

What would are the signs of CLL

Answer 3

most pts are diagnosed on CBC
fatigue and lymphadenopathy
Anemia and thrombocytopenia
Decreased IgG
Nucleus same size as cell

Question 4

the rai system 0

Answer 4

lymphocytosis and no lyphadenopathy

Question 5

rai system 1

Answer 5

lymphocytosis and lynphadenoapthy

Question 6

rai system 2

Answer 6

lymphocytosis and splenomegaly +/- lymphadenopathy

Question 7

rai system 3

Answer 7

lymphocytosis and anemia d/t CLL

Question 8

rai system 4

Answer 8

lymphocytosis and thrombocytopenia d/t CLL

Question 9

CLL tx rai 0 or 1

Answer 9

observation

Question 10

CLL tx rai 2,3 or 4 and signs of weight loss

Answer 10

FLudarabine, cytoxan
fludarabine
bendamustine

Question 11

what are the signs of hairy cell leukemia

Answer 11

cytopenias inculding fever, bleeding, fatigue and SOB
Splenomegaly is common
Lymphadenopathy is not
+CD19&20,11c,103

Question 12

what is the Tx for hairy cell leukemia

Answer 12

purine analogs

Cladribine

Question 13

Malt and Mucosoal associated lymphoid tissue

Answer 13

most have t(11:18)
fusion of API12:MLT that inhibits apoptosis
cells are CD20+ and CD5 neg
caused by h. pylori d/t chronic Ag stimulation

Question 14

Follicular lymphomas

Answer 14

2nd MC of adult lymphomas

Question 15

what are the criteria for FLIPI

Answer 15

age > 60
Increased LDH
Ann arbor III or IV
Hgb<12
extra nodal dz

Question 16

Follicular lymphomas characteristics

Answer 16

positive B cell CD 10&20

Tx is reserved for pt with

Question 17

Burkitts lymphoma is endemic where

Answer 17

sub sahara africa where pt present with Jaw mass

Question 18

what is the cause if Bukitts lymphoma

Answer 18

EBV infection

Question 19

What does the CD test positive for

Answer 19

10,19,20

and oncogene c-MYC

Question 20

how is burkitts tx

Answer 20

high dose chemotherapy

Question 21

what is sezarys syndrome, mycosis fungoides

Answer 21

most present with an III defined diffuse red rash
circulating tumor cell in this disease called sezary
once the disease forms plaques, nodules or lymphadenopathy its called mycosis fungoides

Question 22

what is the treatment for sezary’s syndrome

Answer 22

light therapy

psoralens or topical steroids

Question 23

how does hodgkins lymphoma present

Answer 23

presents with central lymphadenopathy and frequently B symptoms fever weight loss, sweats, +/- puritis
spreads from one adjacent nodal group to the next
Bi modal freq peak age 30 and 70
1/2 are associated with EBV

Question 24

what does Hodgkins lymphoma look like

Answer 24

Reed sternberg cell
multi-lobed nucleus owl appearance
CD 30+
Reactive cells: polys, macrophages, Eos & fibroblasts

Question 25

what is the treatment for hodgkins

Answer 25

ABVD Adriamycin Bleomycin Vinblastine and DTIC

Question 26

what is multiple myeloma

Answer 26

disease of mature functioning B cells which are characterized by the production and over production of Immunoglobulins

Question 27

what is the immunoglobulin in waldenstroms macroglobulinemia

Answer 27

IgM

Question 28

what is the immunoglobulin in multiple myeloma

Answer 28

usually IgG but may be IgA or rarely IgD

Question 29

what is the median age at presentation?

Answer 29

65 yo | 2x frequent in african americans as in caucasians

Question 30

what does the mnemonic CRAB used for

Answer 30

``` multiple myeloma hyper-Calcemia Renal failure Anemia lytic Bone lesions >10% monoclonal plasma cells in the bone marrow serum monoclonal IgG or IgA >3g/dL ```

Question 31

what are symptoms of multiple myeloma

Answer 31

bone pain, particularly back pain pathological fracture hypercalcemia

Question 32

what is the TX of MM

Answer 32

make sure end organ damage is minimized keep well hydrated Call hematologist packed red blood cells for anemia If candidate for hematopoietic stem cell transplant avoid alkylating agents: Lenalidomide, Dexamethasone, Bortezomib If not candidate use melphalan, steroids, bortezomib, proteasome

Question 33

who does waldenstrom macroglobulinemia affect

Answer 33

pt >65 y.o. | cells are positive for CD 19, 20 and surface IgM

Question 34

what are the main symptoms of waldenstrom macroglobulinemia

Answer 34

hyper viscosity d/t elevated IgM lethargy, confusion, weakness, anemia bones lesions absent peripheral neuropathy

Question 35

what is the Tx for waldenstrom macroglobulinemia

Answer 35

plasmapharesis | rituximab & cyclophosphamide