Flashcards in Lymphoma Deck (61)
Loading flashcards...
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
