Weir Questions (Lymphoma and Myeloma)

Question 1

What 4 major factors must a doctor consider when he/she decides if a cure is possible for a patient with lymphoma?

Answer 1

1. Tumor histology
2. Tumor stage
3. Condition of patient
4. Available therapies

Question 2

Name the most common indolent lymphoma. Aggressive lymphoma?

Answer 2

Most common indolent: Follicular

Most common aggressive: Diffuse Large B Cell

Question 3

Be able to stage a patient with lymphoma.

Answer 3

Stage I - single node or lymphoid structure
Stage II - two or more lymph regions one side diaphragm
Stage III - both sides of diaphragm
Stage IV - extranodal beyond E (sole site of disease)

Question 4

What are the major treatment decision differences between indolent and aggressive lymphomas?

Answer 4

Indolent - only treat when symptomatic, response to simple therapies, local irradiation and prednisone
Aggressive - early therapy required, potential cure, combination chemotherapies (CHOP), bone marrow transplant for relapse

Question 5

Understand the mechanism and sites of action of rituximab and ibrutinib.

Answer 5

rituximab - CD20 antigen, complement deposited and cells die

ibrutinib - Bruton tyrosine kinase blocker, cannot activate NF-kB

Question 6

What is the name of the most common cutaneous lymphoma and what cell can you find in the blood of some of these patients?

Answer 6

mycosis fungoides; cells with ceribriform nuclei (in Sezary, the more advanced form of mycosis)

Question 7

What is a common complication of radiation therapy in young Hodgkin’s Disease women?

Answer 7

breast cancer as a secondary malignancy (12% chance)

Question 8

Name two complications of CLL

Answer 8

recurrent infection (I don’t know another one)

Question 9

Name 2 poor prognostic chromosome abnormalities in CLL

Answer 9

17p, 11q deletion

Question 10

When is BMT used in lymphoma?

Answer 10

when an aggressive lymphoma relapses

Question 11

What is an M spike?

Answer 11

protein electrophoresis; where there is a lot of one Ig or monoclonal area

Question 12

What does an IFE tell you?

Answer 12

it will tell you what specific type of Ig you are looking at

Question 13

Name the four components of CRAB

Answer 13

hyperCalcemia, Renal insufficiency, Anemia, Bone destruction

Question 14

Describe the mechanism of bone destruction in myeloma.

Answer 14

myeloma cells make DKK1, leading to increase in RANKL and IL6 by osteoblast progenitor cells and marrow stromal cells; osteoblast differentiation is blocked and osteoclast maturation is stimulated

Question 15

Stage a myeloma with Durie Salmon and ISS.

Answer 15

Durie Salmon - Stage I is Hb>10, Ca12, Bence Jones>12/24 hrs, IgG>7 or IgA>5
ISS - B2M 3.5 is Stage I, B2M5.5 is Stage III

Question 16

Name the worst prognostic chromosome abnormality in myeloma.

Answer 16

17p

Question 17

What 2 classifications of new drugs have changed the way we treat myeloma? Mechanism of action?

Answer 17

IMiD - stimulate NK cells to kill, alter stromal structure

Proteasome inhibitors - degrade proteins

Question 18

When is an autologous transplant indicated in myeloma?

Answer 18

under 70 and in good health

Question 19

Why do Waldenstrom patients become hyperviscous more commonly than myeloma patients?

Answer 19

IgM is a much bigger molecule

Question 20

Name three causes of amyloidosis

Answer 20

monoclonal serum light chains, transthyretin, chronic osteomyelitis