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27 Cards in this Set

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What is the difference between a leukemia and a lymphoma?
Leukemia = malignancy of stem cell precursors originating in the bone marrow

Lymphoma = malignancy of lymphoid cells originating in lymph nodes and lymphoid tissues
What cells lines are responsible for each?
Leukemia = Myeloid blasts, Lymphoid blasts

Lymphomas = B lymphocytes, T lymphocytes, NK lymphocytes
How are lymphomas classified?
Based on cell of origin, level of cell maturity and the natural progression of the disease

Originate from lymph nodes and lymphoid tissues

Classified as aggressive or indolent
What is the characteristic pathology of Hodgekins lymphoma?
What would you look for in terms of histology?
Biopsy?
Reed-Sternberg cell
Histology - Nodular sclerosing, Lymphocyte rich or depleted, mixed cellularity
Biopsy - Cytogenetics, morphology, surface antigens
Describe the staging of Hodgkin's Lymphoma
1 – one group of lymph nodes affected or lymphoma just in one organ of the body
2 – 2 or more groups of lymph nodes affected, they are on the same side of the diaphragm
3 – lymph nodes on both sides of the diaphragm
4 - lymphoma spread outside the lymph nodes to other organs
A symptoms =
asymptomatic
B symptoms =
fever, night sweats, weight loss
These are prognostically unfavorable
X symptoms =
bulky disease
What are the negative prognostic indicators of hodgekin's lymphoma?
Albumin < 4
Hemoglobin < 10.5
Male gender
Stage IV disease
Age > 45
White count > 15,000
Lymphopenia
Score 0-2 =
Score 3 or above =
a 5 year survival of 86%
a 5 year survival of 70%
What is first line therapy for HL in stages 1 and 2?
combination chemo + radiation

Anthracycline based regimen =
doxorubicin
bleomycin
vinblastine
darcarbazine
What is first line therapy for HL in stages 3 and 4?
Combination chemo

Anthracycline based regimen =
Doxorubicin
Bleomycin
Vinblastine
Darcarbazne
+/- radiation for symptomatic relief of bulky tumors
What toxicities are likely with this regimen?
CINV
Cardiotoxicity (doxorubicin)
Pulmonary Toxicity (bleomycin)
Hypersensitivity reaction (bleomycin test dose recommended)
Myelosuppression
Mucositis
Sensory motor paresthesias (vinblastine)
Long term complications (secondary malignancies - leukemia, gondal dysfunction - sterility)
What measures would you take to pacifiy these adverse effects?
CINV - triple antiemetic regimen
Myelosuppression - G-CSF
Cardio - baseline/periodic ECHO
Pulm - baseline/periodic PFTs
What is the goal of HL treatment?
Curative-intent chemotherapy (cure, decrease risk of recurrence and improve survival, minimize acute and long term complications)
How do you monitor HL?
Monitor for complete eradication of the tumor based on imaging as well as resolution of symptoms.
What lab values are you concerned with?
CBC (WBC, platelets)
Liver Function (AST/ALT) Doxo, Vinblastine metabolized through the liver
Renal Function - dose modified for bleomycin and dacarbazine
Describe the staging of Non-Hodgkin's Lymphoma.
Stage 1 = single node, one side of diaphragm, single extranodal
Stage 2 = Multiple nodes, one side of diaphragm, multiple extra nodes,
Stage 3 = Multiple nodes, both sides of diaphragm, multiple extra nodes
Stage 4 = Multiple nodes, both sides of diaphragm, liver, lung, bone marrow
A, B, E, X
A = asymptomatic
B = fever, night sweats, weight loss
E = extranodal disease
X = bulky disease
All histologic variants are aggressive except for Follicular
Diagnosis is by cytogenetics, morphology and surface antigens
Risk Factors =
Immunodeficiency (HIV, Solid organ transplantation, bone marrow transplantation, immunosuppressives, viral infections)
Negative Prognostic Factors =
Age > 60
Extranodal disease > 1 site (liver, lungs, bone marrow)
ECOG status 2 or greater
Stage III or IV disease
Serum LDH > 1x upper limit of normal
Score 0-1 = 5 year overall survival of 73%
Score 2-3 = 5 year overall survival of 43-51%
Score 4 or greater = 5 year overall survival of 26%
Categorize score by aggressiveness (histology) and stage
First line treatment =
Combination Chemo
Anthracycline based regimen (Doxorubicin, Cyclophosphamide, Vincristine, Prednisone) + Rituximab
Toxicities of this regimen =
CINV
Cardiotoxicity
Hypersensitivity reaction (rituximab) - Diphenhydramine
Myelosuppression
Mucositis
Sensory-motor paresthesias (neuropathy - vincristine)
Alopecia
Goal of therapy =
Curative intent (early stage)
Minimize acute complications, decrease risk recurrence and increase long term surival
Monitoring =
Monitor for complete tumor eradication based on imaging and resolution of symptoms.