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Clinical HL FINAL > Lymphomas > Flashcards

Flashcards in Lymphomas Deck (23)
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1
Q

Hodgkin Lymphomas derive from which lymph cell and non derive from which cells?

A

B cell derived

Can be t, b, or NK cell derived

2
Q

What are the two age distributions of HL, which virus and infection is it associated with?

A

15-35 and 55-70

EBV and mono

3
Q

Two major categories of HL and what are the 4 histological types fo the first category?

A

Classic and nodular lymphocyte predominant (men between 30 and 50).
Nodular sclerosis, mixed cellularity, lymphocyte rich and lymphocyte depleted.

4
Q

What is the primary clinical presentation in patients with LAD? What is the second most common presentation? What symptoms can a lot of these patients suffer from?

A

Painless peripheral LAD most commonly seen in cervical and or supraclavicular LNs.

Mediastinal mass on chest x ray.

b symptoms, temp over 38, weight loss of more than 10% of body weight, and drenching night sweats.

5
Q

What is the preferred method of diagnosing and what are we looking for with HL?

A

Ecisional biopsy.

RS cells with a background of inflammatory cells and fibrosis.

6
Q

What two tests are used for the initial staging of HL and what other two tests can be used to help?

A

CT and PET are initial.

Bone marrow biopsy and aspirate

7
Q

What is state 1-4 of Ann Arbor staging system for lymphomas?

A
  1. Single LN region or single extra-nodal organ or site of involvement.
  2. 2 or more LN regions or lymph structures involved on same side of diaphragm
  3. Involvement of LN regions on both sides of diaphragm
  4. Diffuse involvement of one or more extranodal sites or tissues.
8
Q

What are 4 stage modifiers to be familiar with that can change prognosis of the staging?

A

Presence of B symptoms, absence of b symptoms, extranodal site involvement, and bulky mass (more than 10cm).

9
Q

What is the most commonly used chemotherapy regimen for HL?

A

ABVD regimen

Doxorubicin, bleomycin, vinblastine, and dacarbazine

10
Q

How would we treat a patient presenting with early stage HL?

A

2-3 month course of the regimen followed by a course of radiation to the area especially if there is a bulky mediastinal mass.

11
Q

How would we treat advanced state HL?

A

6 months of chemotherapy alone.

12
Q

What is very important concerning follow up with HL patients who are treated with chemo?

A

They are at risk for secondary malignancies due to treatment so its important that they get long term follow up with CBC and imaging.

13
Q

What is recommended prior to starting the ABVD regimen for HL?

A

Baseline cardiac and pulmonary function because of cardiac and pulmonary side effects.

14
Q

The majority of lymphomas in adults are if what cell derivation?

A

B cell

15
Q

What are some common associations with NHL even though the etiology is mostly unknown?

A

Autoimmune conditions, immunodeficiency, infections like EBV, h pylori and chlamydia and hep c.

16
Q

What are the three levels for NHL that we use to identify aggressiveness?

A

Indolent or low grade, aggressive or intermediate, and highly aggressive or high grade.

17
Q

Indolent lymphomas often present with what?

A

Slow progressing LAD and abnormal CBC like anemia, thrombocytopenia, etc.

18
Q

Aggressive lymphomas often present how?

A

Rapid LAD and mass goring with b symptoms and elevated LDH and uric acid.

19
Q

What is the preferred method of diagnosis for NHL?

A

Excisional biopsy

20
Q

All B cell derived NHLs have what two markers and what marker is found on T cell derived NHLs?

A

19 and 20

3

21
Q

What are all the lab values, studies and imaging that needs to be done before chemo treatment that will help with staging?

A

CBC, CMP, calcium, uric acid and LDH
Check HIV, hep b and c because of the association with HIV and viral hepatitis
CT scans of chest, abdomen and pelvis
Bone marrow biopsy and lumbar puncture to see if its bone and CSF

22
Q

What two things do we use in the treatment of B cell NHLs? What is the difference between prognosis of B cell lymphomas and T cell lymphomas?

A

Chemo and anti cd 20 like rituximab

T cell lymphomas have worse prognosis and more likely to relapse

23
Q

Talk about the importance of beta 2 microglobulin and its role with determining prognosis of lymphomas?

A

Beta 2 microglobulin is produced in excess amounts in lymphoproliferative malignancies and it is cleared by the kidneys. Someone with a beta 2 microglobulin greater than 5 have an adverse prognosis compared to someone with the same stage all things equal and has less than 5. Patients with impaired renal function will have elevated baseline beta 2 microglobulin levels, so need to make sure we take patients kidney function into account.