Lymphoma Therapeutics

Question 1

Where are hematologic malignancies located

Answer 1

blood, bone marrow, lymph nodes

Question 2

how is hodgkins lymphoma (HL) characterized

Answer 2

Reed Sternberg Cells

Question 3

what are the risk factors for HL

Answer 3

EBV, impaired immune function (HIV)

Question 4

how does HL present

Answer 4

pruritus
B symptoms (fever, night sweats, unintentional weight loss)

Question 5

what is the gold standard for diagnosing HL

Answer 5

excisional nodal biopsy

Question 6

How is HL staged

Answer 6

early stage favorable
early stage unfavorable
advanced stage

Question 7

what are the unfavorable factors for HL

Answer 7

-large mediastinal adenopathy
-multiple involved nodal regions
-B symptoms
-extranodal involvement
-elevated ESR rate

Question 8

what is the goal with HL

Answer 8

cure with minimal toxicities and long term complications

Question 9

how does neutropenia affect the treatment of HL patients

Answer 9

continue to treat despite neutropenia

Question 10

how to treat early stage favorable HL

Answer 10

ABVD + Radiation
(Doxorubicin, Bleomycin, Vinblastine, Dacarbazine)

Question 11

what are toxicities associated with doxorubicin

Answer 11

cardiotoxicity

Question 12

what are toxicities associated with bleomycin

Answer 12

pulmonary toxicity

Question 13

what is the treatment for early stage unfavorable HL

Answer 13

ABVD + radiation

Question 14

what is the treatment for advanced stage HL

Answer 14

ABVD + radiation or
AAVD (doxorubicin, brentuximab, vinblastine, dacarbazine)

Question 15

how many cycles of ABVD chemo should be used in HL

Answer 15

2-4 cycles in early
6-8 cycles in advanced

Question 16

how to treat relapsed HL

Answer 16

high dose chemo followed by autologous stem cell rescue

Question 17

what are risk factors for non-hodgkin lymphoma (NHL)

Answer 17

infections (EBV, herpes virus, h. pylori) or immunodeficiency

Question 18

how to confirm diagnosis

Answer 18

excisional biopsy is best

Question 19

describe follicular lymphoma

Answer 19

Indolent growing, not typically curable

Question 20

when to treat follicular lymphoma

Answer 20

only if patient is symptomatic or patient preference

Question 21

what can follicular lymphoma turn into

Answer 21

Via Richter’s transformation, follicular lymphoma can turn into an aggressive NHL

Question 22

what should be tested in diffuse large b-cell lymphoma (DLBCL)

Answer 22

double/triple hit (MYC, BCL2, BCL6)

Question 23

what is the treatment for stage I/II DLBCL

Answer 23

R-CHOP + Radiation 3 cycles
R-CHOP 6 cycles

Question 24

what is the treatment for stage III/IV DLBCL

Answer 24

R-CHOP 6 cycles or
Pola + R + CHP 6 cycles

Question 25

what is R-CHOP

Answer 25

rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone

Question 26

what are toxicities in R-CHOP regimens

Answer 26

neutropenia thrombocytopenia

Question 27

what is a concern with rituximab

Answer 27

Hepatitis B reactivation

Question 28

what must be tested prior to the start of anti-CD20 therapy

Answer 28

Hepatitis B Surface Antigen and Hepatitis B Core Antibody

Question 29

if a patient tests positive for HepB surface antigen or core antibody what should they be started on

Answer 29

Entecavir

Question 30

How should relapsed DLBCL/Aggressive NHL be treated

Answer 30

-Salvage chemo followed by autologous stem cell rescue or CAR-T -palliative chemo -BiTE

Question 31

Describe Multiple Myeloma (MM)

Answer 31

abnormal clonal plasma cells infiltrating the bone marrow secrete immunoglobulins that reek havoc

Question 32

what is the presentation for multiple myeloma

Answer 32

CRAB Calcium > 11.5 Renal Dysfunction Scr > 2 or CrCl < 40 Anemia < 10 or 2 less than normal Bone: osteolytic lesions or fractures

Question 33

what is the treatment goal of MM

Answer 33

disease control 1st time treatment needs to be the best, won't respond as well down the road

Question 34

treatment plan for MM

Answer 34

induction (remission) --> consolidation (transplant) --> maintenance

Question 35

when treating MM what you must determine about the patient

Answer 35

are they a stem cell candidate>

Question 36

what is the 3 drug regimen for MM

Answer 36

VRD (Lenalidomide, Dexamethasone, Bortezomib)