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53 Cards in this Set
- Front
- Back
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Where can lymphomas arise from?
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Anywhere in the lymphatic system
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What are the typical presenting symptoms of lymphomas?
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Often none other than enlarged lymph nodes
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What is a a worrying lymph node?
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>2 cm (acorn size)
Painless Neck, under arms, in groin |
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What are some positive symptoms of lymphoma?
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B symptoms:
Fever Night sweats Weight loss Fatigue Pain |
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How do you diagnose lymphomas?
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Biopsy the node
Bone marrow biopsy (sometimes) Peripheral blood |
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During what phase will you see peripheral blood changes in lymphomas?
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Leukemic phase
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What are the types of hodgkin's lymphoma?
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Classical
Non-classical |
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What are the subtypes of classical Hodgkin's lymphoma?
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Nodular sclerosis
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Are there differences between the treatments of the different subtypes of classical Hodgkin's lymphomas?
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No.
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What is the presentation of a non-classical Hodgkin's lymphoma?
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Nodular, lymphocyte predominant
Behaves like an indolent B-cell lymphoma |
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What type of lymphoma is more common: non Hodgkin's or hodgkins?
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Non hodgkin's.
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What is the difference between the incidence of NHL and HD?
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NHL incidence rises with age
HD patients are younger (20-29); peak at 60 |
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What's the difference in spread between HD and NHL?
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HD is more orderly: from lymph node to lymph node
NHL spreads randomly |
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Where are places that aren't commonly infested with HD?
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Waldeyer's ring
Mesenteric nodes CNS Skin GI tract |
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What makes something an AA stage I or II lymphoma? III or IV?
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I or II: one side of the diaphragm
III or IV: both sides of the diaphragm I: one node II: multiple nodes, one diagram III: lymph nodes on both sides of the diaphragm; may be accompanied by the spleen or other extramlymphatic organism IV: lots of fields of radiation within an organ |
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How do you subclassify the lymphoma stages?
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Whether or not they have B symptoms:
Fever Night sweats 10% of their weight is lost |
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What's the treatment of IA, IB, IIA hodgkin's lympoma?
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1. Brief chemo, radiation
2. Radiation to the next contiguous, clinically uninvolved nodal group. Radiation is less and less common. |
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What are the drugs given for Hodgkin?
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ABVD every 2 weeks
Adriamycin Bleomycin Vinblastive Dacarbazine |
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What are the outcomes for early stage Hodgkin's disease?
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>80% recover
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What's the therapy for advanced stages of Hodgkin's disease?
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Essentially, all chemo.
Longer treatment than for limited disease |
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What's the outcome for people with advanced Hodgkins after treatment?
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60% cure rate
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What therapy do you give to people if treatment fails?
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Chemo (if the patient was treated with radiation only)
High dose chemo with autologous stem-cell transplant (60% success) |
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What's the prognosis if the person relapses after stem cell transplant?
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Poor - they're going to die.
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How do we reduce risks for Hodgkin's?
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Try and reduce the treatments to eliminate downstream effects.
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What are the most common types of Non-Hodgkin's lymphomas?
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Diffuse large-B cell
Follicular lymphoma |
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What are the main types of cell simplicated in Non-Hodgkin's lymphoma?
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B-cells
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What types of NHL are indolent?
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Follicular
SLL/CLL MALT |
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What is the pattern of the indolent lymphomas?
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Remiss, relapse continually
Patients survive for >10 years with the disease Can transform to a more aggressive type. |
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What are the aggressive NHLs?
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Diffuse Large B-cell
Curable |
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What are the very aggressive NHLs?
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Burkitt's-like
Lymphoblastic Curable |
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What's the natural history of follicular lymphoma?
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They'll wax and wane on their own for years.
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At what stage do follicular lymphomas typically present? Why?
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Advanced stage
They're typically so slow progressing them that people don't notice them until they get big. |
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As you treat someone with follicular lymphoma, what happens to the disease?
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Shorter and shorter time between the remissions
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What are the risk factors for follicular lymphoma?
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NO-LASH
NO: NOdal sites (>4 vs. <4) L: LDH A: Age (<60, >60) S: Stage (III-IV vs. I-II) H: <120 g/L vs. >120g/L The more risk factors you have, the worse the prognosis. >3 risk factors, you're high risk |
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What is the only type of follicular lymphoma that we can cure?
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Stage I
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What is the initial treatment for the indolent B-cel lymphomas?
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You should do initial observation of the lymphoma: no difference in survival between those who you treat and don't treat early
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What type of therapy do you use for B-cell lymphomas?
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CD-20 antibody: rituximab
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What is the combination therapy for B-cell lymphomas?
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CD-20 antibody (rituximab) + chemotherapy
Better results combined than there would be alone. |
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How does radioimmunotherapy work?
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You put Beta cell emitting molecules on CD-20 antibodies
Drugs: Bexxar Zevalin You only give 1 round of treatment! |
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What's the most common type of aggressive NHL?
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Diffuse large B-cell lymphoma
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What sites in the body with the aggressive NHLs tend to have a higher risk of CNS involvement?
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Bone marrow
Sinuses Testes Breast |
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What is the main therapy for aggressive NHL?
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Chemotherapy
Rituximab + CHOP |
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What patients have a worse prognosis in DLCBL?
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The patients who have activated B-cell germinal centers (ABC)
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What gives people a poor prognosis with NHL?
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Old
1st shot fails at treatment |
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If the first round of treatment for aggressive NHL fails, what do you do?
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Transplant.
If this fails, you are going to die. |
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What are the "double hit" lymphomas?
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C-myc expression and either BCL-2 or BCL-6 translocation
No response to treatment. They're going to die. |
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What are the properties of the mantle cell lymphomas?
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It's intermediate between the indolent and aggressive
Male predominance B-cells |
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How does mantle cell lymphoma normally present?
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Advanced stage
Splenomegaly Circulating lymphoma cells Intestinal involvement (lymphomatous polyposis) |
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What's the treatment of mantle cell lymphoma?
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Rituximab + CHOP
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What's the prognosis for mantle cell lymphoma?
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Poor: they remiss and have resistance to salvage regimens
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What are the properties of Burkitt's lymphoma?
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It grows SUPER FAST!: 100% of the cells grow!
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What's the prognosis for Burkitt's lymphoma?
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It responds well to treatment: you can cure the patient.
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How do you treat lymphoblastic lymphoma?
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Like you treat acute lymphoblastic leukemia
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