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33 Cards in this Set
- Front
- Back
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What are the four categories of lymphomas?
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CD5+ lymphomas (small lymphocytic lymphoma,)
follicle-derived (follicular small cleaved lymphoma and diffuse large cell lymphoma,) Hodgkin's Disease, and aggressive lymphoma (Burkitt's and lymphoblastic lymphoma.) |
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What is the working formulation?
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Low grade lymphomas have slow courses that progress over many years but are often incurable.
High grade lymphomas have acute presentations, pose a high risk of death, but are often curable. Intermediate grade lymphomas are in between. |
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How are the different grades of lymphomas treated?
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Low grade - palliative care,
Intermediate grade - R-CHOP +/- XRT, High grade - like ALL Hodgkin's - ABVD +/- XRT |
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Abnormalities in which chromosomes are commonly associated with lymphomas?
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Chromosome 14 (Ig heavy chain)
Chromosome 2 (kappa light chain) Chromosome 22 (lambda light chain) |
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The changes leading to transformation begin at the ______________.
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Stem cell.
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What conditions are associated with lymphomas and why?
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H. pylori, HIV, EBV, SLE, and Hepatitis C because the more lymphocytes that mature, the higher the risk of lymphoma.
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What causes the proliferation in Burkitt's lymphoma?
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MYC, a transcription factor, gets overexpressed, driving proliferation and elevating LDH.
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How is lymphoblastic lymphoma different? What is its leukemia counterpart?
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Lymphoblastic lymphoma is a disease of T cells. It is the lymph node version of ALL (and is treated like ALL.)
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What age group does lymphoblastic lymphoma affect?
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Lymphoblastic lymphoma affects children and young adults.
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What markers are expressed in lymphoblastic lymphoma?
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CD4, CD8, and TdT.
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Immunoglobulin is to B-cell lymphomas as what is to lymphoblastic lymphoma?
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TCR (T-Cell Receptor)
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What organs/systems need special treatment in lymphoblastic lymphoma and ALL?
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CNS and testicles
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What grade lymphoma is Diffuse Large Cell Lymphoma?
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Diffuse large cell lymphoma is intermediate grade.
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What are the two types of Diffuse Large Cell Lymphoma?
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Germinal center B-cell like (expresses genes characteristic of gernimal B cells), and
Activated B-cell like (expresses genes characteristic of plasma cells, post-germinal cell phenotype) |
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What gene is associated with Diffuse Large Cell Lymphoma?
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BCL6 (3q27). BCL6 is a trancription repressor; when it is overactive and turns genes off, maturatioin is arrested and cells persist in an undifferentiated state.
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At what stage does the genesis of follicular small cleaved lymphoma occur?
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Class switching, somatic hypermutation, affinity maturation (post-germinal)
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What translocations are follicular lymphomas associated with?
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Most follicular lymphomas are associated with translocations of BCL2 (18q21) and the heavy chain (14q23.) When turned on, BCL2 inhibits apoptosis.
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What lymphoma is the equivalent of CLL?
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SLL, Small Lymphocytic Lymphoma
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What is the clinical course of SLL?
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SLL is slow-growing, incurable, and often presents with stage IV disease.
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What is the malignant cell in Hodgkin's Disease?
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Reed-Sternberg cell (likely derived from a B cell, many typical B cell genes are not expressed)
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What are the four types of Hodgkin's Disease, and which one has a clinical course that is different?
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Nodular Sclerosis
Lymphocyte Depleted Mixed Cellularity Lymphocyte Predominant (affects older individuals, has a more indolent course.) |
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What treatment is used for HD?
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ABVD (MC, LD, and NS)
rituximab (LP) |
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How is Hodgkin's different from Non-Hodgkin's Lymphoma?
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A majority of the cells are reactive, spreads to adjacent lymph node groups, often presents in mediastinum, mass after treatment, bimodal age distribution, often curable.
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When should you suspect lymphoma?
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Asymptomatic (large nodes, anemia)
Mass effects (mediastinal mass = substernal pain, cough, dyspnea, abdominal mass = pain, early satiety, hyperbilirubinemia) Weight loss, night sweats, fever |
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What are some characteristics of a lymph node that would make you want to biopsy it?
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Size (over 2 cm),
Growth rate (over weeks to months) Pain (painless is c/w lymphoma) |
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What are the four stages of lymphoma?
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Stage I: single nodal region
Stage II: two or more on the same side of the diaphragm Stage III: two or more on opposite sides of the diaphragm Stave IV: liver or bone marrow involvement |
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What do E and B stand for?
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E = extranodal site
B = B symptoms (weight loss, night sweats, fever) |
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What is LASSS?
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IPI calculation:
LDH: > normal LDH Age: > 60 Stage: III or IV Site: > 1 extranodal site Status: > or equal to 2 |
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What are the three types of lymphoma treatment?
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Palliative (SLL, follicular small cleaved cell)
Curative (DLCL, Burkitt's, lymphoblastic, Hodgkin's) Instensive (bone marrow transplant, generally for relapsed patients) |
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When are radiation/chemo used in Hodgkin's and DLCL?
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Stage I, II = RADIATION + chemo
Stage III, IV = CHEMO + radiation |
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What is the standard therapy for Hodgkins?
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ABVD:
adriamycin bleomycin vinblastine dacarbazine |
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What is the standard therapy for DLCL?
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R-CHOP:
rituximab cyclophosphamide adriamycin vincristine prednisone |
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What is rituximab?
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Rituximab is a monoclonal a-CD20 antibody
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