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Therapeutics IV > Lymphoma - Block 4 > Flashcards

Lymphoma - Block 4 Flashcards

1
Q

Types of lymphoma?

A
  1. Hodgkin’s dx
  2. Non-Hodgkin’s Lymphoma
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2
Q

RF of lymphoma?

A
  1. Epstein-Barr Virus
  2. Immunosuppressed patients
  3. Family hx
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3
Q

What are reed-sternberg cells?

A

Cells associated with HD (malignant B cells)
* Owel eye cells

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4
Q

Presentations of HD?

A
  1. Fatigue, malaise
  2. Enlarged lymph node
  3. B sx: unexplained fever, night sweats, weight loss
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5
Q

How is HD diagnosised?

A
  1. Biopsy
  2. Imaging
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6
Q

Staging used for HD?

A

Ann Arbor
Stage 1: single node or site
Stage 2: Two or more lymph node or sites on same side of diaphragm
Stage 3: lymph node involvement on both sides of diaphragm
Stage 4: diffuse or disseminated involvement of organs/tissues
A: no fever (asymptomatic)
B: B-sx
X: bulky dx (nodal mass >10 cm)

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7
Q

What are objective RF of HD?

A
  • Serum albumin (< 4 g/dL)
  • Hemoglobin (< 10.5 g/dL)
  • Male
  • Stage IV disease
  • Age (> 45 yo)
  • Leukocytosis (WBC >15,000/mm3)
  • Lymphocytopenia (< 600/mm3)
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8
Q

What is early-stage favorable HD?

A

Disease is stage I to II with no unfavorable risk factors

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9
Q

What is early-stage unfavorable HD?

A

Disease is stage I to II with unfavorable risk factors
* B symptoms,extranodal disease, bulky disease, 3+ nodes

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10
Q

What is advanced stage HD?

A

Disease is stage III to IV

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11
Q

Tx options for lymphoma?

A
  1. Chemotherapy
  2. Radiation
  3. Stem cell transplant
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12
Q

What are the primary chemo regimens?

A
  1. MOPP
  2. ABVD
  3. Stanford V
  4. BEACOPP
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13
Q

What are the components of MOPP?

A
  1. Nitrogen mustard
  2. Vincristine
  3. Procarbazine
  4. Prednisone
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14
Q

Components of ABVD?

A
  1. Doxorubicin
  2. Bleomycin
  3. Vinblastine
  4. Dacarbazine
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15
Q

What are the components of Stanford V?

A
  1. Nitrogen mustard
  2. Doxorubicin
  3. Vinblastine
  4. Vincristine
  5. Bleomycin
  6. Etoposide
  7. Prednisone
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16
Q

What are the components of BEACOPP?

A
  1. Bleomycin
  2. Etoposide
  3. Doxorubicin
  4. Cyclophosphamide
  5. Vincristine
  6. Procarbazine
  7. Prednisone
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17
Q

Downsides of using MOPP?

A

Sterility and malignancy from nitrogen mustard

18
Q

Presentations of early stage favorable?

A

Stage IA and IIA:
1. No fever
1. No B-symptoms
1. No mediastinal mass

19
Q

Tx for early stage favorable?

A

Combination Chemotherapy +/- Radiation Therapy:
1. ABVD or Stanford V
2. Usually 4 cycles of ABVD or 2 cycles (8 weeks) Stanford V
3. Restage after chemo and then after radiation

20
Q

What is the prognosis of having early stage favorable?

A

> 90% for dx free progression and overall survival rate

21
Q

What are the presentations of earlyy stage unfavorable?

A

Stage 1-2:
* Mediastinal mass
* Symptomatic (B-sx)
* Numerous sites of dx
* Elevated ESR
* Poor prognostic facotrs

22
Q

Tx for early stage unfavorable?

A

Combination Chemotherapy followed by Radiation Therapy:
* ABVD or Stanford V (BEACOPP also possible)
* Usually 4 cycles of ABVD or 3 cycles (12 weeks) Stanford V
* Restage after chemo and then after radiation

23
Q

Tx for advanced stage disease?

A

Stage 3-4:

Combination Chemotherapy is treatment of choice:
* ABVD or Stanford V
* BEACOPP for high-risk pt (IPS > 4)
* Radiation may be used to minimize bulky disease

24
Q

What is the goal for relapse tx?

25
Indications for relapse tx?
* Fail radiation alone; successful with MOPP or ABVD * Fail chemo worse prognosis
26
# I Tx for relapse tx?
**First line:** Autologous stem cell txpt **Second line:** Caution with anthracycline use * Brentuximab vedotin-  CD30+ antibody-conjugate * Bendamustine  * Lenalidomide * Everolimus
27
What are the long term complications of HD chemo?
1. Secondary malignanices (breast, lung, GI) requiring annual x rays and mammograms 2. Cardiac toxicity 3. Fertility issues 4. Hypothyroidism
28
Chemo regimen used if infertility was a concern?
ABVD
29
What are the RF of NHL?
1. Autoimmune dx 2. AIDS 3. Solid organ transplant 4. Infection (H. pylori, HIV, EBV) 5. Chemical exposure (Organophosphates, pesticides) 6. Chromosomal abnormalities
30
How is the common cause of NHL?
About 80-90% NHL are of B cell origin
31
Presentations of NHL?
1. Lymphadenopathy 2. B sx (less common than HD) 3. Enlargement of spleen and liver 4. Ab pain
32
How do you diagnose NHL?
Tissue biopsy
33
How do you stage NHL?
1. Labs 2. Imaging 3. Ann Arbor Staging (used but less important for prognosis than in HD) 4. Bone marrow biopsy
34
Prognosic facotrs of NHL?
1. Age >60Y 2. Abnormal LDH levels 3. Performance status ≥2 4. Ann Arbor stage 3-4 5. Extranodal involvement ≥2 sites
35
What are the types of tx for NHL?
1. Indolent (%40): supportive care 2. Aggressive (60%): cure if possible, relieve symptoms, minimize toxicities
36
NHL are based on what facotrs?
1. Age 2. Specific site/type/stage 3. Pt preference 4. Comorbidities
37
Tx options for NHL?
1. Radiation 2. Chemo 3. Monoclonal antibodies
38
Monoclonal Ab used for NHL? MOA?
Rituximab: Monoclonal antibody directed against CD20 antigen on B-lymphocytes
39
ADR of rituximab? Tx of ADR?
* Infusion reactions: pre-medicate with acetaminophen 650 mg and diphenhydramine 50 mg, 30 mins prior to infusion * Step up infusion * HepB testing prior, can reactivate HepB * If HepB reactivated, treat with appropriate antivirals * Do not use in patients with active infections
40
What are the tx approaches to indolent lymphoma?
Not curative: **Conservative:** watch and wait -> treat sx **Aggressive:** treat immediately
41
What supportive care do we need to consider for NHL?
Tumor lysis syndrome: hydration and allopurinal

Therapeutics IV (39 decks)

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