Oncology > Lymphomas > Flashcards

Lymphomas Flashcards

(41 cards)

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1
Q

What is NHL?

A

proliferation of malignant T or B cells and their precursors

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2
Q

What are risk factors for NHL?

A

1, genetics (Wiskott-Aldrich syndrome, severe combined immunodeficiency)
2. Autoimmune diseases
3. Immunosuppression (HIV/AIDs, Graft-versus-hist disease)
4. chronic pharmacologic immune suppression (solid organ transplant)
5. infection
6. radiation
7. chemicals

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3
Q

What infections may cause NHL?

A
  1. Epstein barr virus
  2. human T cell lymphotropic virus
  3. human herpes virus 8
  4. H. pylori
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4
Q

What chemicals may cause NHL?

A
  1. benzene
  2. herbicides
  3. insecticides
  4. some chemo
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5
Q

What are the 3 types of NHL?

A
  1. indolent
  2. aggressive
  3. highly aggressive
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6
Q

How does NHL present?

A
  1. should be painless
  2. non-contiguous pattern of spread
  3. possible “B” symptoms
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7
Q

What is the treatment for indolent NHL?

A
  1. observation
  2. radiotherapy
  3. Rituximab +/- bendamustine
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8
Q

What is the MOA of Rituximab?

A
  1. monoclonal antibody binds to CD20+ receptors of expressing lymphoid cells
  2. complement-dependent apoptosis
  3. macrophage-mediated killing
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9
Q

What are adverse effects with Rituxumab?

A
  1. infusion-related reactions (hypotension, bronchospasm, angioedema, fever, chills, rigors, pruritus, dyspnea)
  2. reactive latent infections (HepB, chicken pox/ shingles)
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10
Q

Why is indolent NHL usually incurable?

A

cells divide so slow chemo is not effective

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11
Q

What is the treatment for aggressive NHL?

A
  1. R-CHOP (standard)
  2. R-CVP (gentle)
  3. R-EPOCH (most aggressive)
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12
Q

What agents are in R-CHOP?

A

Rituximab
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone

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13
Q

How many cycles should R-CHOP be given?

A

max 8; give 2 cycles after the patient’s best response

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14
Q

What are adverse events with cyclophosphamide?

A
  1. myelosuppression/ mucositis
  2. N/V/D
  3. alopecia
    (blind stupid chemo)
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15
Q

What are adverse events with Doxorubicin?

A
  1. extravasation
  2. cardiac toxicity
  3. urinary color changes
  4. myelosuppression
  5. N/V
    alopecia
    (bling stupid chemo)
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16
Q

What are adverse events with Vincristine?

A
  1. peripheral neuropathy
  2. extravasation
  3. constipation
  4. alopecia
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17
Q

What are adverse events with prednisone?

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A
  1. insomnia
  2. increased appetite
  3. hyperglycemia
  4. psychosis
  5. edema
18
Q

What agents are used for refractory NHL?

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A

no anthracycline given; Rituximab + agents not used OR radioimmunotherapy

19
Q

What is given in combination with high-dose chemo for highly aggressive HNL?

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A

CNS/ cranial irradiation

20
Q

What agents are used to treat highly aggressive NHL?

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A

R-CHOP is not adequate; need more

21
Q

How do HIV-associated lymphomas present?

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A
  1. large B-cell and Burkett’s lymphoma
  2. profound B symptoms
22
Q

What are treatment strategies for HIV associated lymphomas?

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A
  1. low dose chemo regimens to decrease immune suppression
  2. concurrent antiretroviral treatment
  3. CNS prophylaxis/ cranial irradiation
23
Q

What is the etiology of HL?

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A
  1. infection (EBV)
  2. immunosuppression (HIV, organ transplant)
  3. higher socioeconomic background
24
Q

What is the histology of HL?

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A

Reed-Sternberg cells

25
What is the reason Reed-Sternberg cells have an "owl eyes" appearance?
cells have 2 nuclei; possible fusion of reticular cells, B cells, T cells, or both lymphocytes
26
How does HL present?
1. lymphadenopathy (enlarged, painless lymph nodes) 2. "B" symptoms 3. alcohol-induced lymph node pain 4. pruritis
27
What are "B" symptoms?
1. fever >38 degrees C for unknown reason 2. drenching night sweats 3. unexplained weight loss (loss of 10% of body weight in 6 months before diagnosis)
28
How does HL progress?
1. contiguous spread to adjacent lymph nodes 2. more aggressive over time 3. spreads to liver, bone marrow, bone
29
What factors cause a poorer prognosis factor for HL?
1. + "B" symptoms 2. male 3. older age
30
What is the goal of HL treatment?
cure in all patients
31
What agents are used to treat HL?
ABVD: Doxorubicin Bleomycin Vinblastine Dacarbazine
32
What is the treatment of early favorable stage IA and IIA HL?
ABVD (2-4 cycles) + XRT
33
What is the treatment for early unfavorable IB and IIB HL?
ABVD (4-6 cycles) + XRT
34
What is the treatment for advanced favorable IIIA and IVA HL?
ABVD (6-8 cycles)
35
What is the treatment for advanced unfavorable IIIB and IVB HL?
AVBD (6-8 cycles)
36
What is the maximum amount of cycles of AVBD a patient can get?
8 cycles due to Doxorubcin
37
What is the difference between favorable and unfavorable HL?
presence of B symptoms
38
What are side effects with Bleomycin?
1. pulmonary fibrosis 2. hypersensitivity
39
What are side effects with Vinblastine?
1. peripheral neuropathy 2. extravasation 3. constipation
40
What are side effects with Dacarbazine?
1. myelosuppression 2. N/V
41
What are treatments for refractory/ relapsed HL?
1. Brentuximab (antiCD30 monoclonal antibody) 2. alternate chemo 3. stem cell transplant
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