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Flashcards in Lymphomas Deck (53):
1

What are risk factors for HL?

EBV, HIV
Immunosuppression

2

What is the presentation of HL?

Asymptomatic lymphadenopathy
Discovery of mediastinal mass on x-ray
B-symptoms
Pain following alcohol consumption

3

What is asymptomatic lymphadenopathy?

Persisting for > 1 month, may wax and wane
Painless, rubbery
Nodal involvement usually systematic or logical

4

What are B-symptoms?

>10% wt loss in 6 months
Fever
Night sweats
Pruritus

5

What types of cells are associated with HL?

Reed-sternberg cells

6

What type of imaging technique is used to diagnose HL?

Integrated PET/CT scan

7

What is Stage I from Cotswolds-Ann Arbor system?

Single lymph node region or lymphoid structure

8

What is stage II from Cotswolds-Ann Arbor system?

Multiple lymph nodes on same side of diaphragm

9

What is stage III from Cotswolds-Ann Arbor system?

Multiple lymph nodes on both sides of diaphragm

10

What is stage IV from Cotswolds-Ann Arbor system?

Lymph node involvement and extensive involvement of liver, lung, bone marrow, or another extralymphatic organ

11

What does A stand for in the Cotswolds-Ann Arbor system?

Absence of systemic symptoms

12

What does B stand for in the Cotswolds-Ann Arbor system?

B symptoms

13

What does the E stand for in the Cotswolds-Ann Arbor system?

Extranodal involvement

14

What are unfavorable factors in HL?

Bulky disease (mass > 10 cm)
ESR > 50 (if asx)
> 3 sites
B symptoms

15

What are the factors used in the IPI for HL?

Serum albumin (< 4)
Hgb (< 10.5)
Male
Stage IV
Age (45+)
WBC (> 15,000)
Lymphopenia (< 600 or <8% of WBC count)

16

What is the goal for HL?

Maximize potential for cure

17

What is the standard of care for HL?

ABVD

18

What is ABVD?

Doxorubicin
Bleomycin
Vinblastine
Dacarbazine

19

What are the stage I/II (favorable) treatment options?

Chemo +/- involved site radiation therapy (ISRT)
After 2-4 cycles, restage PET/CT

20

What are thestage I/II (unfavorable) and advanced disease treatment options?

Chemo (ABVD)
After chemo - restage, then chemo/ISRT

21

What are options for relapsed HL diseases?

Autologous HSCT
HD chemo
Everolimus
Lenalidomide
Nivolumab/pembrolizumab

22

What are the RFs for NHL?

Genetic
Exposures
Infections

23

What part of genetics affects NH:?

Compromised immune system: congenital and acquired immunodeficiency conditions
Cytogenetic abnormalities: t(8;14), t(14;18)**, t(11;14)

24

What type of exposures are RFs for NHL?

Herbicides
Pesticides
Radiation
Dyes

25

What infections are RFs for NHL?

EBV
HIV
HTLV-1
H pylori
HCV

26

What is the presentation for NHL?

Peripheral lymphadenopathy
B symptoms
Fatigue, malaise, pruritus
Extranodal involvement

27

Is NHL peripheral lymphadenopathy systematic/logical?

No

28

What is the diagnosis of NHL?

Hx and PE
Excisional node biopsy
Possibly bone marrow biopsy
Scans
Labs: CBC with dif, LDH, CMP, LFTs, Hep B
Immunophenotyping w/ immunochemistry and/or flow cytrometry

29

What are the classifications of NHL?

Indolent
Aggressive
Highly aggressive lymphoma/acute leukemia

30

What is an indolent lymphoma?

Follicular

31

Are indolent lymphomas curable?

No

32

Are aggressive/ highly aggressive lymphomas curable?

Potentially

33

What is an aggressive lymphoma?

Diffuse large B-Cell lymphoma

34

If a patient has a follicular lymphoma and remains untreated, how long is their survival?

Years

35

If a patient has diffuse large B cell lymphoma and remains untreated, how long is their survival?

Months

36

What factors are used in the Lugano modification staging system?

Nodal involvement
Extranodal status

37

What is stage I per the Lugano modification?

Single lymph node region or lymphoid structure
Single extranodal lesion w/o nodal involvement

38

What is stage II per the Lugano modification?

Two ore more nodal groups on same side of diaphragm
Stage I or II by nodal extent with limited contiguous extranodal involvement

39

What is stage II "bulky" per the Lugano modification?

II with "bulky" disease

40

What is stage III per the Lugano modification?

Nodes on both sides of diaphragm or nodes above the diaphragm with spleen involvement

41

What is stage IV per the Lugano modification

Additional non-contiguous extralymphatic involvement

42

What are RFs for NHL that lead to a worse prognosis?

Age > 60
High stage
B symptoms
Elevated Serum LDH

43

What stages are considered localized follicular lymphoma?

Non-bulk Stage I or II

44

What are treatment options for localized follicular lymphoma?

Local radiation
Watch and wait if asx or radiation toxicity is a concern

45

What are considered advanced follicular lymphomas?

Stage III or IV
Any bulky disease

46

What are the therapies for advanced follicular lymphomas?

Local radiation therapy
BP
CHOP-R
RCVP
Rituximab
Radioimmunotherapy
Stem Cell transplant

47

What is CHOP-R?

Cyclophosphamide
Doxorubicin
Vincristine
Prednisone-rituximab

48

What is DLBCL?

Diffuse Large B Cell lymphoma

49

What is the typical presentation of DLBCL?

Rapidly enlarging sx masses

50

What is the treatment goal for DLBCL?

Cure

51

What is the therapy for DLBCL?

CHOP-R +/- Locoregional Radiation therapy

52

What is double hit lymphoma?

Type of DLBCL with MYC rearrangement and BCL2 and/or BCL6 rearrangement

53

If a patient has double hit lymphoma, what does that mean for prognosis?

Poor
Use more intense regimens than CHOP-R