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Clinical Medicine- Heme/Onc > Lymphoma > Flashcards

Flashcards in Lymphoma Deck (23)
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1
Q

4 subtypes of HL?

A

Nodular sclerosis, lymphocyte predominant, lymphocyte depleted, mixed cellularity

2
Q

Prognosis of HL depends on?

A

Depends more on stage than type of HL

3
Q

What type of cell is present in HL? What is this cell predominantly derived from?

A

Reed-Sternberg cell; nearly all from B cells

4
Q

Name the staging classifications for HL?

A

Stage I- single node/region. Stage II- 2 or more nodal regions on same side. Stage III- nodal regions on both sides of diaphragm (includes spleen). Stage IV- diffuse involvement, visceral involvement (BM, liver). A (asymptomatic) vs B (symptomatic)

5
Q

Treatment for limited stage (Stage I/II, no B or bulky tumor?

A

Chemotherapy followed by radiation

6
Q

Treatment for advanced stage (Stage III/IV, B signs, bulky tumor)?

A

Multi agent chemotherapy. ABVD.

Adriamycin, Bleomycin, Vinblastine, Dacarbazine. Given every 2 months for 6 cycles. Goal is cure!

7
Q

Complications of treatment?

A

Fertility issues, cardiac toxicity, secondary malignancies, immune dysfunction, pneumonitis, avascular neocrosis, dental carries, hypothyroidism

8
Q

Which is more common, HL or NHL?

A

NHL

9
Q

Types of non-Hodgkins lymphoma?

A

Diffuse large B cell lymphoma (curable), Follicular lymphoma `(non-curable)

10
Q

Clinical presentation of DLBCL?

A

Rapidly advancing symptomatic mass (neck, abdomen), B symptoms, elevated LDH

11
Q

Initial labs and test for DLBCL?

A

CBC, CMP, LDH, Hep B, Uric Acid. BM aspiration/biopsy, baseline cardiac assessment prior to anthracycline, CT/PET/CT

12
Q

Staging for DLBCL and FL?

A

Staging is the same for HL except for A/B symptoms

13
Q

What are A and B symptoms?

A

A-asymptomatic. B- fever, night sweats, weight loss

14
Q

Treatment for limited stage (I or II) DLBCL?

A

Radiation alone, limited chemo (3-4 cycles) followed by involved field XRT, full course chemo

15
Q

Treatment of advanced stage (III/IV) DLBCL?

A

Chemo and immunotherapy. R-CHOP. Rituximab (monoclonal antibody), Cyclophosphamide, Hydroxydaunorubicin, Oncovorin, Prednisone. Goal is to cure. Every 3 weeks for 6 cycles

16
Q

What do you want to completed during chemo treatment and at the end?

A

PET/CT 2-3 weeks into treatment. 6-8 weeks following completion. Repeat BM biopsy if +

17
Q

When would symptoms of relapse generally present?

A

Within the first 2 years. Want to follow up with patient every 3 months in 1st 2 years and then every 6 months. Relapses are generally symptomatic

18
Q

How would someone with Follicular lymphoma present?

A

Indolent lymphoma (little or no pain). Asymptomatic peripheral lymphadenopathy that wax and wane. Large abdominal masses. Usually present in advanced stage

19
Q

Initial evaluation for FL?

A

CBC, CMP, LDH, beta 2 microglobulin, Hep B, BM asp/biopsy, CT of chest, abdomen, pelvis with IV contrast or PET/CT, baseline cardio testing

20
Q

FL treatment for early stage FL?

A

Consider FL XRT alone, no benefit of chemo, can observe

21
Q

Indications for treatment in advanced stage FL?

A

Symptoms, steady progression, bulky disease, threatened end organ function, cytopenia secondary to lymphoma

22
Q

Advanced stage FL treatment?

A

Rituximab single agent. Combined immuno and chemo- R-CHOP or BR (bendamustine and rituximab). Radioimmunotherapy- Ibritumomab tiuxetan or Tositumomab

23
Q

Complications of BM failure in NHL?

A

Anemia and thrombocytopenia