Lymphoma Cases

Question 1

What age groups does Hodgkin’s lymphoma affect most often? In which is is considered a “common” cancer?

Answer 1

young people (15-25ish) and old people (70s)

It’s considered common in young people just because they have so few cancers

Question 2

How do you make a lymphoma diagnosis - any lymphoma diagnosis?

Answer 2

YOU NEED TO TAKE AN EXCISIONAL BIOPSY

and do flow cytometry on it

Question 3

What’s the standard chemo regimen for HD?

Answer 3

ABVF: adriamycin, bleomycin, vinblastine, dacarbazine

Question 4

How do we stage lymphomas?

Answer 4

stage 1: only one lymph node affected
stage 2: two or more lymph nodes affected on the same side of the diahragm
stage 3: two or more lymph nodes above and below the diaphragm
stage 4: widespread disease with multiple organs affected

Question 5

Is HD considered a curable cancer?

Answer 5

yes - goal is always to cure regardless of stage

Question 6

What are the most common secondary tumors after chemo for HD?

Answer 6

solid tumors: lung cancer and breast cancer

leukemias

Question 7

Besides secondary cancers, what are some late effects of therapy for HD?

Answer 7

heart disease (from radiation to mediastinum)
Lung disease
impaired fertility

Question 8

What chemo drug is a particular culprit for lung disease?

Answer 8

bleomycin

Question 9

What will the immunohistochemistry markers be for HD?

Answer 9

sdf

Question 10

If a biopsy shows effased lymph node architecture with a CD5-, CD19+, CD20+, CD23- large lymphocytes, what’s the diagnosis?

Answer 10

Diffuse large B cell lymphoma

Question 11

How does the IPI Scoring system work for prognosis?

Answer 11

You get a point for the followin gparameters and the higher score you have, the worse your prognosis: age over 60 years, performance status of 2-4, stage 3-4 disease, LDH elevated, extranodal - more than 1 site

Question 12

What’s the most common NHL in adults?

Answer 12

diffuse large B cell lymphoma

Question 13

What’s the chemo regimen for DLBCL?

Answer 13

R-CHOP

Question 14

What’s the most common INDOLENT NHL? (DLBCL is aggressive)

Answer 14

follicular lymphoma

Question 15

Why do most follicular lymphomas present as advanced stage?

Answer 15

because they’re often asymptomatic until late stage

Question 16

Is the goal of treatment a cure or not in follicular lymphoma

Answer 16

nope - not curable with chemo

Question 17

What’s the genetic abnormality in follicular lymphoma?

Answer 17

t(14:18) - you put Bcl2 near an IgH, so you don’t have apopotsis - this is why it’s a slow growing tumor - the cells just aren’t dying

Question 18

When do you initiate treatment for the indolent NHLs?

Answer 18

when forced to: the “pushy nodes” (causing hydronephrosis, jaundice, dysphagia, stridor), cytpoenias, B symptoms and fatigue

Question 19

What’s the most aggressive of the B-cell lymphomas?

Answer 19

burkitt’s

Question 20

Besides DLBCL, what’s the other aggressive B cell lymphoma (but not as bad as BUkitts)?

Answer 20

Mantle cell

Question 21

If a biopsy shows CD20+ CD5+, CD23- atypical lymphocytes that stain strongly for cyclin D1, what is it”

Answer 21

mantle cell lymphoma

Question 22

what’s the translocation in mantle cell lymphoma?

Answer 22

t(11:14) - you get cyclin D next to IgH

Question 23

If flow cytometry shows CD19+ CD20+ (dim), CD10-, CD23+, kappa neg, lambda pos (dim), and CD5+, what do they have?

Answer 23

CLL

Question 24

Why is the kappa negative, lambda positive super significant?

Answer 24

Because if the lymph node is just a reactive node, you’d have a mix of the two - that only one is positive means it’s a monoclonal expansion

Question 25

How do you stage CLL?

Answer 25

Rai:
stage 0 - lymphocytosis with leukemia cells in blood or marro
1 - lymphocytosis with lymphadenopathy at any site
2 - lymphocytosis with organomegaly with or without lyphadeopthy
3 - disease-related anemia
4- disease-related thrombocytpenia

Question 26

Do you automatically need to treat CLL?

Answer 26

no - there is NO survival benefit with early treatment of low risk patients

Question 27

What is the most common genetic abnormality in CLL> Good or bad prognosis?

Answer 27

13q14.3 - favorable prognosis

Question 28

If a biopsy taken during an EGD revealed nodules with lymphocytic infilatration of the stomach mucosa with the following markers: CD20+, CD10-, CD5-, CD23-, what is it?

Answer 28

malt lymphoma

Question 29

What bacteria is associated with malt lymphoma?

Answer 29

h. pylori

Question 30

If a patient has a solid organ transplant and put on immune suppressors, after which they develop what apears to be a lymphoma with EBV-induced poly-clonal expansion of B cells, what’s the issue?

Answer 30

The immune suppressors include a calcineurin inhibitor that’s blockign activagin of T cells, so you don’t get T cell inhibition on B cells so they go crazy

Question 31

What targeted drug do we have for CD20?

Answer 31

Rituximab - works great for B cell lymphomas