Term
|
Definition
lymphoma is a malignant transformation of immune cells that reside predominantly in lymphoid tissue
bone marrow and thymus
lymph nodes, spleen, Waldeyer's Ring, lamina propira of GI tract
2 major types of lymphoma:
Hodgkin's Disease
Non-Hodgkin's Lymphoma |
|
|
Term
|
Definition
slight male predominance
HD: bimodal age distribution (20s and 60s)
NHL: average age 65
HD: overall 5 year survival 82%
NHL: overall 5 year survival 53% |
|
|
Term
| lymphoma work up and diagnosis |
|
Definition
work up: history and physical, laboratory, radiographic evaluation
biopsy of pathologic tissue:
lymph node excisional biopsy preferred
want to remove the entire lymph node to look at the architecture of the lymph node
bone marrow biopsy |
|
|
Term
|
Definition
symptoms come and go
adenopathy (enlarged lymph nodes): usually painless and rubbery
adenopathy complications
pruritis
B symptoms: fever, night sweats, weight loss
bone marrow involvement = myelosuppression |
|
|
Term
| lymphoma Cotswolds Staging (NEED TO KNOW) |
|
Definition
Stage I:
involves a single LN region or single extra lymphatic organ or site
Stage II:
involves 2 or more LN regions on the same side of the diaphragm
Stage III:
involves LN regions on both sides of the diaphragm
Stage IV:
disseminated multi-focal involvement
bone marrow involvement |
|
|
Term
| Hodgkin's Disease (HD) - etiology |
|
Definition
origin is unknown
environment factors
infection - EPSTEIN BARR
Reed-Sternberg (RS) cell is the malignant clone
thought to be B-cell in origin but has lost the B cell characteristics (including CD20 receptor)
do express the CD30 receptor
genetic factors |
|
|
Term
| hodgkin's disease - poor prognostic factors |
|
Definition
albumin < 4
Hgb < 10.5
male
age > 45
stage IV
WBC > 15
lymphocytes < 600 (0.6)
4 OR MORE POOR PROGNOSTIC FACTORS = HIGH RISK OF RELAPSE |
|
|
Term
| hodgkin's disease treatment |
|
Definition
goal is to obtain the highest possible cure rate for all patients while minimizing side effects
surgery has minimal to no role
radiation - controversial b/c of collateral damage
chemotherapy |
|
|
Term
|
Definition
involved nodal region
extended field/regional radiotherapy:
mantle irradiation (upper chest)
para-aortic irradiation
ADRs:
side effects are local
xerostomia, hypothyroidism, pneumonitis, cardiotoxicity, infertility
lymph node regions: cervical (neck), supra-clavicular (above clavicle), mediastinal (middle chest), axillary (arm pit), periaortic, illiac, inguinal, femoral |
|
|
Term
| HD treatment - chemotherapy |
|
Definition
1st cancer successfully treated with chemotherapy
use aggressive combination chemo
ABVD:
doxorubicin
bleomycin
vinblastine
dacarbazine
Stanford V |
|
|
Term
| HD treatment - early stage |
|
Definition
early stage; favorable = stage IA, IIA (no B-symptoms):
90% cure rate and 80% long term survival
chemotherapy (2 cycles) + involved node radiation
early stage; unfavorable = Stage IB, IIB (B-symptoms):
long term survival in 87%
chemotherapy + involved node radiation
give 2 cycles beyond complete response (minimum 4) |
|
|
Term
| HD treatment - advanced state |
|
Definition
stage III-IV
CR in 60-90%
long term survivors 40-50%
chemotherapy (6-8 cycles)
minimum 6 cycles
should get 2 cycles after CR seen |
|
|
Term
|
Definition
radiation alone as initial therapy: chemotherapy
chemotherapy as initial therapy: stem cell transplant
stem cell transplant is not therapeutic but allows you to give an even higher dose of chemotherapy b/c not worried about the dose limiting toxicity of bone marrow suppression
brentuximab vedotin:
targets CD-30
attached to antimicrotubule agent (auristatin)
indicated as 3rd line therapy |
|
|
Term
| ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) major counseling poinast |
|
Definition
fertility
Quick ADRs:
hypersensitivity
extravastation (anthracycline)
Short Term ADRs:
N/V
myelosuppression
mucositis
alopecia
neuropathies (vinblastine)
red secretions
blood clots (bleomycin)
Long Term ADRs:
cardiac toxicity
pulmonary toxicity (bleomycin) |
|
|
Term
| Non-Hodgkin's Lymphoma (NHL) - etiology |
|
Definition
origin is unknown
immunosuppression: acquired, congenital, drug induced
autoimmune disorders
infection: EBV, H. pylori, HHV8, HTLV1
chemical: herbicides, organophosphate, nuclear, and chemotherapy exposure |
|
|
Term
|
Definition
monoclonal proliferation of malignant B or T lymphocytes and their precursors
80% are B cell lymphomas
description of cells (size and nuclear features), where they are found (follicular or diffuse), and cell surface markers determine normal counterpart, tumor growth characteristics and treatment |
|
|
Term
|
Definition
subtypes often associated with specific features
local or general adenopathy: painless, rubbery LN
bone marrow involvement: anemia, neutropenia, thrombocytopenia
GI involvement: nausea, vomiting, pain |
|
|
Term
|
Definition
indolent (low grade): follicular grade I and II, mantle cell, MALT
aggressive (intermediate grade): follicular grade III, large/diffuse B cell
highly aggressive (high grade): burkitt's and burkitt's like
untreated clinical course (time to death):
indolent - years (10 years)
aggressive - months (6-12 months)
highly aggressive - weeks (6-12 weeks)
types of lymphomas:
indolent - nodal (mantle or follicular) and extranodal (MALT)
aggressive - diffuse large B cell and peripheral T cell
highly aggressive - lymphoblastic,, burkitts, and adult T cell
presentation:
indolent - wax and wane adenopathy
aggressive - B symptoms or symptoms of obstruction
highly aggressive - rapidly growing mass |
|
|
Term
|
Definition
goals: relieve symptoms, cure disease, minimize toxicity
options:
chemotherapy
radiation
biological agents |
|
|
Term
| NHL treatment - follicular |
|
Definition
indolent disease
early stage (I/II):
observation
localized radiation if symptomatic
advanced stage (III/IV) disease:
indications for treatment - symptomatic, threatened end organ function, cytopenias, massive bulk, steady progression, patient choice
treatment options:
fludarabine + rituximab
maintenance rituximab: dosed every 8 weeks for up to 2 years after initial chemotherapy is done
relapsed disease:
radiopharmaceuticals (ibritumomab-ytrium, tositumomab-iodinine)
bendamustine |
|
|
Term
| NHL treatment - gastric MALT |
|
Definition
early stage (I/II):
treat H. pylori
advanced stage (III/IV):
indications - bleed, massive bulk, symptoms, progression, danger to end organ function, patient preference
chemotherapy - CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) + rituximab
H. pylori treatment |
|
|
Term
| NHL treatment - diffuse large B cell |
|
Definition
most common form of NHL
early stage (I/II):
CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) x 4 cycles + rituximab
followed by radiation
advanced stage (III/IV):
CHOP x6-8 cycles + rituximab
treat 2 cycles beyond CR
relapse:
multidrug combination regimens
stem cell transplant |
|
|
Term
| R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) major counseling points |
|
Definition
Quick ADRs:
hypersensitivity
extravasation
Short Term ADRs:
N/V
myelosuppression
mucositis
alopecia
neuropathies
red secretions
Long Term ADRs:
cardiac toxicity |
|
|
Term
| NHL treatment - highly aggressive: Burkitt's and lymphoblastic lymphoma |
|
Definition
all stages (I-IV) treated the same
combination chemotherapy:
alkylating agent, anthracycline, HD methotrexate, intrathecal chemotherapy
hyper CVAD
low response rate, few cures
clinical trials |
|
|
Term
hyper CVAD
course 1: cyclophosphamide, mesna, vincristine, doxorubicin, dexamethasone
course 2: methotrexate, leucovorin, cytarabine
major counseling points |
|
Definition
Quick ADRs:
hypersensitivity
extravastation
Short Term ADRs:
N/V
myelosuppression
MUCOSITIS - methotrexate
alopecia
neuropathies
red secretions
hemorrhagic cystitis - cyclophophamide
Long Term ADRs:
cardiac toxicity
VERY TOXIC
VERY COMPLICATED
MUST BE INPATIENT |
|
|
Term
|
Definition
NHL incidence 80% increased in incidence
2/3 highly aggressive histology: Burkitt's, primary CNS
chemotherapy based on type |
|
|
