4.2 Lymphoma - Comeau

hodgkins lymphoma (HL):

epidemiology facts

most common in men and white

50% of HL cases are caused by…

EBV

risk of HL is 3-7x higher if the patient has…

a family member with it

what is the diagnostic hallmark of HL

reed sternberg cells

if a pt has reed sternberg cells, what cancer do they have?

HL

what is the most common symptom of HL?

painless lymph node

list common signs and symptoms of HL

painless lymph nodes

mediastinal mass

B symptoms

pruritis

metastases

what are the B symptoms?

any or all of the following: fever, drenching night sweats, unintentional weight loss

describe pruritis seen in pts with HL

associated with alcohol intolerance

what type of physical exam is done to diagnose HL

cervical and axillary

to be diagnosed with HL, what must be done?

physical exam

biopsy

CT or PET scan

bone marrow biopsy

lab work

T or F:

al pts with HL will get chemothearpy. and the goal is always cure.

T

treatment regimen for stage I-II HL

(abbreviation only)

ABVD

treatment regimen for stage III-IV HL

(abbreviation only)

NAVD or BrECADD

what does ABVD stand for?

adriamycin / DOX

bleomycin

vinblastine

dacarbazine

ADE of adriamycin or DOX

cardiac toxicity, irreversible HF

monitoring required for pts on adriamycin / DOX

routine ECHO

ADE of bleomycin and what makes it worse?

pulmonary toxicity

use of GSF

hx of COPD and smoking

T or F:
of the vinca alkaloids, only vincristine should not be intrathecally injected

F

dacarbazine ADE

N/V

name the ADE associated with each medication in the ABVD regimen:

1. Adriamycin/DOX

2. bleomycin

3. vinblastine

4. dacarbazine

1. cardio tox

2. pulm tox

3. none listed

4. N/V

which drug in the ABVD regimen requires CINV prophylaxis with dexamethaone, an NK1 antagonist, a 5HT inhibitor, and olanzapine?

dacarbazine

ABVD regimen is indicated for pts with stage ____ HL (select all that apply)

a. I

b. II
c. III

d. IV

a and b

all pts must have a _____ test before they start ABVD

lung function test

what are the drugs in the NAVD regimen:

1. N

2. A

3. V

4. D

1. Nivolumab

2. Adriamycin/ DOX

3. vinblastine

4. dacarbazine

ADE of Nivolumab

immune related ADE

which drug in the NAVD regimen causes iRAEs?

nivolumab

NAVD is indicated in patients with stage _____ HL

a. stage I and II

b. stage I only

c. stage III-IV

d. stage III only

c

patients with stage III HL who are 60 yrs or older, are recommended _____

a. ABVD

b. NAVD

c. BrECADD + G-CSF

d. any of the above

b

BrECADD + G-CSF name the drugs included

Brentuximab

etoposide

cytoxan

DOX

dacarbazine

dexamethasone

peg-filgrastim

ADE of brentuximab

peripheral neurotoxicity

why is a G-CSF added to the BrECADD regimen?

to help with myelosuppression effects of the other drugs

which is more intense?

a. ABVD

b. NAVD
c. BrECADD + G-CSF

d. all are the same intensity

c

pts on BrECADD + G-CSF will need to be treated prophylactically for _____ with _____

PJP; bactrim

non-HL: epidemiology

more common in men and white

etiology of NON-HL:

environmental factors

pesticides and radiation

How does immunosuppression contribute to non-Hodgkin lymphoma?

HIV/AIDS, medications, and disease states that suppress the immune system increase risk

Which viruses are associated with non-Hodgkin lymphoma?

EBV

Endemic Human T-cell lymphotropic virus type 1

Human Herpes Virus 8 (HHV8)

Which virus is associated with endemic T-cell lymphoma?

Human T-cell lymphotropic virus type 1

What bacterial infection is associated with a Gastric MALT of non-Hodgkin lymphoma? and what is dr comeaus favorite part of this?

Helicobacter pylori;

if you treat the infection, you cure the cancer

Which type of lymphoma is associated with H. pylori infection?

Gastric MALT lymphoma

what type of malignancy is more common in Non-HL?

a. macrophages

b. T cells

c. RBCs

d. B cells

d

what are the three subtypes of Non-HL?

indolent (follicular)

aggressive (DLBCL)

highly agressive

what is the curability of the following?

1. indolent / follicular non-HL

2. aggressive / DLBCL non-HL

3. highly aggressive non-HL

1. incurable

2. potential

3. potential

symptoms of aggressive (DLBCL) non-HL

B symptoms and massive lymphadenopathy

symptoms of indolent (follicular) non-HL

lymphadenopathy

hepatomegaly

splenomegaly

T or F:
the diagnosis of HL and Non-HL is the same

T

all pts with aggressive (DLBCL) non-HL, will receive ____ treatment

systemic

aggressive DLBCL non-HL:

stage I or II treatment

RCHOP

what drugs are in RCHOP

rituximab

cytoxan

DOX
vincristine

prednisone

aggressive DLBCL non-HL:

stage II extensive, III, or IV treatment OPTIONS

RCHOP or Pola-R-CHP

what are the drugs in Pola-R-CHP

polatuzumab

rituximab

cytoxan

DOX

prednisone

RCHOP causes ________ CINV, so pts will need prophylactic tx

moderate to high

T or F:
RCHOP does not cause myelosuppression

F

rituximab ADE

infusion reactions

HBV reactivation

how to prevent rituximab induced infusion reactions

APAP and diphenhydramine

how to prevent HBV reactivation from rituximab

entecavir x 12 months after completion of therapy

vincristine ADE

peripheral neuropathy

constipation

intrathecal injection causes death

polatuzumab ADE

infusion reactions

peripheral neuropathy

myelosuppression

how to prevent infusion reactions induced by polatuzumab

APAP and diphenhydramine

how to prevent peripheral neuropathy and myelosuppression induced by polatuzumab?

GCSF (pegfilgrastim)

pts on Pola-R-CHP require prophylactic treatment for _____

PJP and HSV

pts on Pola-R-CHP cannot take ____ due to risk of neuropathy

vincristine

indolent (Follicular) non-HL:

conservative/ asymptomatic pts how to treat?

watch adn wait

indolent (Follicular) non-HL:

aggressive/ symptomatic pts, treatment method

CD20 mab + chemo (chemoimmunotherapy)

what are ALL of the options for chemoimmunotherapy?

(treatment options for follicular/ indolent non-HL)

1. obinutuzumab + bendamustine

2. obinutuzumab + CHOP

3. obinutuzumab + CVP

4. Rituximab + bendamustine

5. Rituximab + CHOP

6. Rituximab + CVP

7. Rituximab alone

when would a patient with indolent non-HL revive only rituximab weekly as cancer treatment?

if they are elderly or unfit

pts with indolent non-HL require maintenace treatment with ____ for ____

rituximab; 2 years

bendamustine ADE

myelosuppression

skin reactions

bendamustine requires prophylactic treatment for ____ with _____

PJP; bactrim

shingles ; acyclovir and valcyclovir

T or F:

obintuzumab has the same ADE of R but more infusion reactions

T