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Flashcards in Lymphoma Deck (61)
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1

What are lymphomas?

malignancies that develop from lymphocytes. The site of the maturation defines the type of lymphoma present

2

Clinically, what can lymphomas do to people?

-mass presence (LAD, ureteral obstruction, cord compression)
-replacement (pancytopenia)
-reduction (hypogammaglobinemia)
-tumor products (uric acid, calcium lysis)
-paraneoplastic (AHA, ITP, neuropathy)
-toxicity of therapy (infected, numb and short of breath)

-psychosocial/economic: broke and alone

3

What things does a physician need to know if order to treat a lymphoma patient?

-tumor histology
-tumor stage
-condition of patent
-available therapies

4

How is lymphoma histology divided clinically?

indolent
aggressive
highly aggressive
B or T cell

5

What are indolent (low grade) lymphomas?

slowly progressive, tend to be higher stage (more widespread), and tend to respond to simple therapies

tend to be incurable (except stage I-II)

6

T or F. Survival of indolent lymphoma is independent of early treatment

T. Treatment is more based on symptomatic presentation

7

What are some examples of indolent lymphomas?

-follicular (most common indolent)
-small lymphocytic/CLL
-MALT lymphomas
-Mycosis fungoides

not curable mostly

8

What do aggressive lymphomas look like?

often lower stage, rapidly progressive, requires complex therapies

tend to be curable

9

T or F. Survival of aggressive lymphoma is independent of early treatment

F. Early therapy required

10

What are some examples of aggressive lymphomas?

-diffuse large B cell
-mantle cell
-peripheral T cell lymphoma (NOS, anaplastic, angioimmunoblastic)

11

What are some examples of highly aggressive lymphomas?

-Burkitt/ Burkitt like
-T cell lymphoblastic lymphoma

12

What is a "stage 1" lymphoma?

single node or lymphoid structure

13

What is a "stage 2" lymphoma?

two+ lymph regions on one side of the diaphragm

14

What is a "stage 3" lymphoma?

lymph nodes on both sides of diaphragm

15

What is a "stage 4" lymphoma?

disease is extranodal beyond E

16

What is stage I/II E?

lymphoma originated in an extra nodal area and spread to adjacent lymph nodes

17

What are some tests used in staging lymphoma patients?

-H&P
-chest, abdomen, and pelvis CAT
-PET scan
-bone marrow aspirate and biopsy (CD20)
-CBC, LDH, check CSF

18

What does a PET scan allow?

irradiates nuclei so that you can see functional changes in lymph nodes in lymphoma whereas normal lymph nodes would not show up on the PET scan

19

What is the most common lymphoma?

diffuse large B cell (then follicular)

20

What is the International Prognosis Index?

Age>60 1
Stage III-IV 1
LDH elevated 1
P status >1 1
Extranodal sites > 1 1

APLES

Low risk: 0-1
Low intermediate risk: 2
High intermediate risk: 3
High risk: 4

5 yr. Survival
0-1 73%
2 51%
3 43%
4-5 26%

21

What is the Follicular lymphoma IPI?

Age > 60
Nodal sites > 4
LDH increased
Stage III-IV
Hemoglobin

0-1 = 90% 5 yr sv
2 = 77% 5 yr sv
3-5 = 52% 5 yr sv

22

What are some therapy options for indolent lymphomas?

remember, don't treat unless symptomatic

-local irradiation
-Alkylators and prednison
-Anthracyclines
-Fludarabine
-CD20 antibodies
-Combo chemo

23

What are some therapy options for aggressive lymphomas?

-combo chemo-CHOP; HyperCVAD
-antibody therapy plus CHOP (rituximab)
-radio-immunotherapy
-autologous BM transplant for relapse (survival advantage)

24

What is CHOP?

cyclophosphamide, hydroxydaunorubicin,
oncovin (vincristine),
prednisone

25

What is the antibody drug against CD20?

Rituximab- activates complement or phagocytosis

26

T or F. Adding rituximab to CHOp therapy for diffuse B cell lymphoma helps a lot

T. Almost always use R-CHOP therapy

27

What is the current therapy for stage I/II (IE/IIE) intermediate grade NHL?

CHOP-3 plus RT (stage 1-83% 5 yr survival; stage II-74%)

28

What is the current therapy for stage bulky II/IIE, III, and IV intermediate grade NHL?

CHOP-8

(stage II bulky -49% 5 yr survival; stage III/IV-46%)

29

What is the current therapy for first relapse for all stages of intermediate grade NHL?

autotransplant (53% 5 yr survival)
DHAP (32% 5 yr survival)

30

What drug targets CD52 (B and T cells)?

alemtuzumab