Flashcards in Lymphoma Deck (61)
What are lymphomas?
malignancies that develop from lymphocytes. The site of the maturation defines the type of lymphoma present
Clinically, what can lymphomas do to people?
-mass presence (LAD, ureteral obstruction, cord compression)
-tumor products (uric acid, calcium lysis)
-paraneoplastic (AHA, ITP, neuropathy)
-toxicity of therapy (infected, numb and short of breath)
-psychosocial/economic: broke and alone
What things does a physician need to know if order to treat a lymphoma patient?
-condition of patent
How is lymphoma histology divided clinically?
B or T cell
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)
T or F. Survival of indolent lymphoma is independent of early treatment
T. Treatment is more based on symptomatic presentation
What are some examples of indolent lymphomas?
-follicular (most common indolent)
not curable mostly
What do aggressive lymphomas look like?
often lower stage, rapidly progressive, requires complex therapies
tend to be curable
T or F. Survival of aggressive lymphoma is independent of early treatment
F. Early therapy required
What are some examples of aggressive lymphomas?
-diffuse large B cell
-peripheral T cell lymphoma (NOS, anaplastic, angioimmunoblastic)
What are some examples of highly aggressive lymphomas?
-Burkitt/ Burkitt like
-T cell lymphoblastic lymphoma
What is a "stage 1" lymphoma?
single node or lymphoid structure
What is a "stage 2" lymphoma?
two+ lymph regions on one side of the diaphragm
What is a "stage 3" lymphoma?
lymph nodes on both sides of diaphragm
What is a "stage 4" lymphoma?
disease is extranodal beyond E
What is stage I/II E?
lymphoma originated in an extra nodal area and spread to adjacent lymph nodes
What are some tests used in staging lymphoma patients?
-chest, abdomen, and pelvis CAT
-bone marrow aspirate and biopsy (CD20)
-CBC, LDH, check CSF
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
What is the most common lymphoma?
diffuse large B cell (then follicular)
What is the International Prognosis Index?
Stage III-IV 1
LDH elevated 1
P status >1 1
Extranodal sites > 1 1
Low risk: 0-1
Low intermediate risk: 2
High intermediate risk: 3
High risk: 4
5 yr. Survival
What is the Follicular lymphoma IPI?
Age > 60
Nodal sites > 4
0-1 = 90% 5 yr sv
2 = 77% 5 yr sv
3-5 = 52% 5 yr sv
What are some therapy options for indolent lymphomas?
remember, don't treat unless symptomatic
-Alkylators and prednison
What are some therapy options for aggressive lymphomas?
-combo chemo-CHOP; HyperCVAD
-antibody therapy plus CHOP (rituximab)
-autologous BM transplant for relapse (survival advantage)
What is CHOP?
What is the antibody drug against CD20?
Rituximab- activates complement or phagocytosis
T or F. Adding rituximab to CHOp therapy for diffuse B cell lymphoma helps a lot
T. Almost always use R-CHOP therapy
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%)
What is the current therapy for stage bulky II/IIE, III, and IV intermediate grade NHL?
(stage II bulky -49% 5 yr survival; stage III/IV-46%)
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)