Lymphomas

Question 1

What are risk factors for HL?

Answer 1

EBV, HIV

Immunosuppression

Question 2

What is the presentation of HL?

Answer 2

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

Question 3

What is asymptomatic lymphadenopathy?

Answer 3

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

Question 4

What are B-symptoms?

Answer 4

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

Question 5

What types of cells are associated with HL?

Answer 5

Reed-sternberg cells

Question 6

What type of imaging technique is used to diagnose HL?

Answer 6

Integrated PET/CT scan

Question 7

What is Stage I from Cotswolds-Ann Arbor system?

Answer 7

Single lymph node region or lymphoid structure

Question 8

What is stage II from Cotswolds-Ann Arbor system?

Answer 8

Multiple lymph nodes on same side of diaphragm

Question 9

What is stage III from Cotswolds-Ann Arbor system?

Answer 9

Multiple lymph nodes on both sides of diaphragm

Question 10

What is stage IV from Cotswolds-Ann Arbor system?

Answer 10

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

Question 11

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

Answer 11

Absence of systemic symptoms

Question 12

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

Answer 12

B symptoms

Question 13

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

Answer 13

Extranodal involvement

Question 14

What are unfavorable factors in HL?

Answer 14

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

Question 15

What are the factors used in the IPI for HL?

Answer 15

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

Question 16

What is the goal for HL?

Answer 16

Maximize potential for cure

Question 17

What is the standard of care for HL?

Answer 17

ABVD

Question 18

What is ABVD?

Answer 18

Doxorubicin
Bleomycin
Vinblastine
Dacarbazine

Question 19

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

Answer 19

Chemo +/- involved site radiation therapy (ISRT)

After 2-4 cycles, restage PET/CT

Question 20

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

Answer 20

Chemo (ABVD)

After chemo - restage, then chemo/ISRT

Question 21

What are options for relapsed HL diseases?

Answer 21

Autologous HSCT
HD chemo
Everolimus
Lenalidomide
Nivolumab/pembrolizumab

Question 22

What are the RFs for NHL?

Answer 22

Genetic
Exposures
Infections

Question 23

What part of genetics affects NH:?

Answer 23

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

Question 24

What type of exposures are RFs for NHL?

Answer 24

Herbicides
Pesticides
Radiation
Dyes

Question 25

What infections are RFs for NHL?

Answer 25

``` EBV HIV HTLV-1 H pylori HCV ```

Question 26

What is the presentation for NHL?

Answer 26

Peripheral lymphadenopathy B symptoms Fatigue, malaise, pruritus Extranodal involvement

Question 27

Is NHL peripheral lymphadenopathy systematic/logical?

Answer 27

No

Question 28

What is the diagnosis of NHL?

Answer 28

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

Question 29

What are the classifications of NHL?

Answer 29

Indolent Aggressive Highly aggressive lymphoma/acute leukemia

Question 30

What is an indolent lymphoma?

Answer 30

Follicular

Question 31

Are indolent lymphomas curable?

Answer 31

No

Question 32

Are aggressive/ highly aggressive lymphomas curable?

Answer 32

Potentially

Question 33

What is an aggressive lymphoma?

Answer 33

Diffuse large B-Cell lymphoma

Question 34

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

Answer 34

Years

Question 35

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

Answer 35

Months

Question 36

What factors are used in the Lugano modification staging system?

Answer 36

Nodal involvement | Extranodal status

Question 37

What is stage I per the Lugano modification?

Answer 37

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

Question 38

What is stage II per the Lugano modification?

Answer 38

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

Question 39

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

Answer 39

II with "bulky" disease

Question 40

What is stage III per the Lugano modification?

Answer 40

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

Question 41

What is stage IV per the Lugano modification

Answer 41

Additional non-contiguous extralymphatic involvement

Question 42

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

Answer 42

Age > 60 High stage B symptoms Elevated Serum LDH

Question 43

What stages are considered localized follicular lymphoma?

Answer 43

Non-bulk Stage I or II

Question 44

What are treatment options for localized follicular lymphoma?

Answer 44

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

Question 45

What are considered advanced follicular lymphomas?

Answer 45

Stage III or IV | Any bulky disease

Question 46

What are the therapies for advanced follicular lymphomas?

Answer 46

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

Question 47

What is CHOP-R?

Answer 47

Cyclophosphamide Doxorubicin Vincristine Prednisone-rituximab

Question 48

What is DLBCL?

Answer 48

Diffuse Large B Cell lymphoma

Question 49

What is the typical presentation of DLBCL?

Answer 49

Rapidly enlarging sx masses

Question 50

What is the treatment goal for DLBCL?

Answer 50

Cure

Question 51

What is the therapy for DLBCL?

Answer 51

CHOP-R +/- Locoregional Radiation therapy

Question 52

What is double hit lymphoma?

Answer 52

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

Question 53

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

Answer 53

Poor | Use more intense regimens than CHOP-R