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27 Cards in this Set
- Front
- Back
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What is the difference between a leukemia and a lymphoma?
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Leukemia = malignancy of stem cell precursors originating in the bone marrow
Lymphoma = malignancy of lymphoid cells originating in lymph nodes and lymphoid tissues |
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What cells lines are responsible for each?
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Leukemia = Myeloid blasts, Lymphoid blasts
Lymphomas = B lymphocytes, T lymphocytes, NK lymphocytes |
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How are lymphomas classified?
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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 |
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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 |
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Describe the staging of Hodgkin's Lymphoma
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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 |
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A symptoms =
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asymptomatic
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B symptoms =
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fever, night sweats, weight loss
These are prognostically unfavorable |
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X symptoms =
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bulky disease
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What are the negative prognostic indicators of hodgekin's lymphoma?
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Albumin < 4
Hemoglobin < 10.5 Male gender Stage IV disease Age > 45 White count > 15,000 Lymphopenia |
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Score 0-2 =
Score 3 or above = |
a 5 year survival of 86%
a 5 year survival of 70% |
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What is first line therapy for HL in stages 1 and 2?
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combination chemo + radiation
Anthracycline based regimen = doxorubicin bleomycin vinblastine darcarbazine |
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What is first line therapy for HL in stages 3 and 4?
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Combination chemo
Anthracycline based regimen = Doxorubicin Bleomycin Vinblastine Darcarbazne +/- radiation for symptomatic relief of bulky tumors |
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What toxicities are likely with this regimen?
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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) |
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What measures would you take to pacifiy these adverse effects?
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CINV - triple antiemetic regimen
Myelosuppression - G-CSF Cardio - baseline/periodic ECHO Pulm - baseline/periodic PFTs |
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What is the goal of HL treatment?
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Curative-intent chemotherapy (cure, decrease risk of recurrence and improve survival, minimize acute and long term complications)
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How do you monitor HL?
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Monitor for complete eradication of the tumor based on imaging as well as resolution of symptoms.
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What lab values are you concerned with?
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CBC (WBC, platelets)
Liver Function (AST/ALT) Doxo, Vinblastine metabolized through the liver Renal Function - dose modified for bleomycin and dacarbazine |
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Describe the staging of Non-Hodgkin's Lymphoma.
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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 |
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A, B, E, X
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A = asymptomatic
B = fever, night sweats, weight loss E = extranodal disease X = bulky disease |
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All histologic variants are aggressive except for Follicular
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Diagnosis is by cytogenetics, morphology and surface antigens
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Risk Factors =
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Immunodeficiency (HIV, Solid organ transplantation, bone marrow transplantation, immunosuppressives, viral infections)
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Negative Prognostic Factors =
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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 |
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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
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First line treatment =
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Combination Chemo
Anthracycline based regimen (Doxorubicin, Cyclophosphamide, Vincristine, Prednisone) + Rituximab |
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Toxicities of this regimen =
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CINV
Cardiotoxicity Hypersensitivity reaction (rituximab) - Diphenhydramine Myelosuppression Mucositis Sensory-motor paresthesias (neuropathy - vincristine) Alopecia |
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Goal of therapy =
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Curative intent (early stage)
Minimize acute complications, decrease risk recurrence and increase long term surival |
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Monitoring =
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Monitor for complete tumor eradication based on imaging and resolution of symptoms.
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