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29 Cards in this Set
- Front
- Back
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where in the stem cell differentiation does NHL occur
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lymphoid stem cell
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what is the function of B cells and T cells
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B cells = humoral immunity
T cells = cell mediated immunity |
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what factors increase risk of NHL
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immunosuppression (transplant, auto immune disorders)
infectious agents environmental genetic abnormalities |
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what genetic abnormalities increase risk of NHL
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t (8;14) - burkets
t (14; 18) - follicular t (11;14) |
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what infectious agents increase risk of NHL
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epstein barr virus
HTLV-1 Herpes H. pylori |
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what classification is Diffuse Large Cell lymphoma
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aggressive
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what classification of NHL is not curable
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indolent b/c it grows slows and won't respond to chemo
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how does NHL present
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asymptomatic
peripheral lympadenopathy fatigue, malaise, pruritis B symptoms extranodal disease |
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what are the B symptoms
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fever (>100,4 F or 38 C)
night sweats weight loss ( > 10% tbw over 6 months must be unintentional/unexplained) |
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what are the stages of the Ann Arbor staging system
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stage 1 = disease in single LN or small LN group
stage 2 = disease in two or more LN on SAME SIDE of diaphragm and/or spleen stage 3 = disease on BOTH SIDES of diaphragm and/or spleen stage 4 = disease in extranodal sites |
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what do the various subscripts mean
A B E X |
A - no B symptoms
B - B symptoms E - extranodal site X - bulky tumor > 10 cm |
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what are the international prognostic index factors
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age > 60
performance status >= 2 lactate dehydrogenase (LDH) > NORMAL extranodal sites >= 2 stage 3 or 4 ***one point for each low 0-1 low/intermediate 2 high/intermediate 3 high 4-5 |
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what are the treatment modalities for NHL
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chemotherapy
biological therapy radiation therapy stem cell transplant |
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what is used in biological therapy and how does it work
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Rituximab is used and it works by targeting CD20
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what are the mechanisms of action of rituximab
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antibody cell mediated cytotoxicity
complement dependent killing initiation of apoptosis |
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read up on radiation therapy
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read up on radiation therapy
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what is the purpose of Stem cell transplant in NHL pts
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the pt must first be chemosensitive
they are then given a high dose of chemotherapy used to wipe out the lymphoma then given autologous stemm cells to help bone marrow recover from chemo given |
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how is Diffuse large B cell lymphoma treated
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R-CHOP
rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone |
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what are the 1st line therapies for DLBCL
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1) R-CHOP q 21 days
2)R-CHOP q 14 days 2)R-EPOCH 2)Autologous SCT |
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what is the first line therapy for a pt that presents with
Stage 1/2, Non-Bulky <10 cm, no adverse risk factors |
RCHOP 3 cycles + RT
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what is the first line therapy for a pt that presents with
Stage 1/2, Non-Bulky <10 cm, w/ adverse risk factors |
RCHOP 6-8 cycles +/- RT
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what is the first line therapy for a pt that presents with
Stage 1/2, Bulky >10 cm |
RCHOP 6-8 cycles + RT
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what is the first line therapy for a pt that presents with
Stage 3/4 |
RCHOP 6-8 cycles
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what are the SE of RCHOP
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rituximab - infusion reactions
cyclophosphamide - hemorrhagic cystitis doxorubicin - cardiotoxicity vincristine - neurotoxicity prednisone - ulcers, HTN, hyperglycemia myelosuppression, n/v, alopecia in general |
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what is used for CNS prophylaxis in DLBCL
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4-8 doses of methotrexate and/or cytaribine usually given once per cycle
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what patients is CNS prophylaxis for DLBCL recommended
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testicular, paranasal sinus, epidural, bone marrow involvement
AIDS related lymphoma >= 2 extranodal sites |
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what is 2nd line (salvage) therapy for DLBCL
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chemotherapy + autologous SCT
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what is the treatment of choice for relapsed/refractory chemosensitive DLBCL pts
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chemotherapy + autologous SCT
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what is the treatment of choice for newly diagnosed pts
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R-CHOP
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