Disorder
frequency
Lymphoblastic
85% of childhood acute
Leukemia/ Lymphoma B leukemias; peak in incidence at
age 4
cell
Lymphoblastic
Leukemia/ Lymphoma T
cell
Small Lymphocytic
Lymphoma/Chronic
Lympocytic Leukemia
Lymphoplasmacytic
Lymphoma
Solitary Myeloma
(Plasmacytoma)
Smoldering Myeloma
Monoclonal
Gammopathy of
Uncertain Significance
(MGUS)
Follicular Lymphoma
Burkitt Lymphoma
Marginal Zone
Lymphoma
5% of adult lymphomas
Hodgkin Lymphoma
Mixed-cellularity
Hodgkin Lymphoma
LymphocytePredominance Hodgkin
Lymphoma
Lymphocyte-Depletion
least common form of HL (< %)
Hodgkin Lymphoma
Peripheral T cell
Lymphoma
Adult T-cell
Leukemia/Lymphoma
Large Granular
rare neoplasm of T cell and NK
cell; occurs in adults
Lymphocytic Leukemia
Extranodal NK/T cell
Lymphoma
Mycosis
Fungiodes/Sezary
Syndrom
ABVD
Doxorubin, Bleomycin,
Vinblastine, Dacarbazine
BEACOPP
bleomycin, etoposide,
doxorubicin,
cyclophasphamide, vincristine,
procarbazine, prednisone
R-CHOP
Rituximab, cyclophosphamide,
doxoroubin, vincristine,
prednisone
ICE
Ifosfamide, carpoplatin,
etoposide
pathogenesis
genetic features
overexpresison of cyclin D1
promotes S phase progression
during cell cycle
inappropriate
"overexpression" of BCL2
protein in the tumor cells and
contributes to tumor cell
survival
reactive lymphocytes =
majority of celluraity
30-40% mutations in
transcription factor STAT3
salient morphology
immunophenotype
classic HL
clinical features
diagnosis
fatigue, painless
lymphadenopathy, generalized
disease involving bone marrow,
spleen, liver, and GI
cervical or axillary
lymphadenopathy
lymphadenopathy, sometimes
eosinophilia, pruritis, fever,
weight loss
infiltration of bone marrow,
liver, spleen -> splenomegaly,
pancytopenia, hepatomegaly
(some cases), infection
skin lesions,
lymphadenopathy,
hepatosplenomegaly,
peripheral blood lymphocytosis,
hypercalcemia
mild to moderate
lymphocytosis, anemia, Felty's
syndrome (RA, splenomegaly,
neutropnia)
destructive nasopharyngeal
mass, less often presents w/
involvement of skin and testis
skin lesions (premycotic phase,
plague phase, tumor phase)
prognosis
treatment
aggressive/fatal, but w/
urgent initation of treatment,
intensive combo chemo and
dose-adjusted R-EPOCH, RCHOP
anti-CD20 immunotherapy,
+/- radiation; RCHOP then ICE
complete remissions and
+/- radiation
achieved in 60-80% of patients
excellent
comments
myeloma manifests as
disseminated bone disease,
often w/ destructive lytic
lesions; "CRAB" hypercalcemia, renal
involvement, anemia, bone
lytic lesions/back pain
Drug
Daunorubicin
Subclass
anthracyclines
Idarubicin
Doxorubicin
cytarabine
methotrexate
mercaptopurine
fludarabine
Leucocovorin
MTX rescue
Glucarpidase
MTX rescue
cyclophosphamide
ifosfamide
carmustine
alkylating agents
melphalan
bendamustine
decarbazine
procarbazine
vincristine
Vinca Alkaloids
Vinblastine
Vinorelbine
Etoposide
topoisomerase II
inhibitors
Thalidomide
Lenalinomide
antiangiogenic agents
Pomalidomide
Carboplatin
Cisplatin
platinum analogs
platinum analogs
Oxaliplatin
Imatinib
Dasatinib
Ponatinib
tyroskine kinase
inhibitors
Nilotinib
Busotinib
Bortezomib
Carfizomib
Ixazomib
proteosome inhibitors
Rituximab
monoclonal antibodies
Brentuximab
Vedotin
Elotuzumab
Bleomycin
ATRA
Omacetaxine
Panobinostat
MOA
Indications
Contraindications
multiple uses in
malignancy; CNS
prophylaxis/treatment
(able to cross BBB);
AML, lymphomas
cancers: leukemias
(ALL), lymphomas,
choriocarcinoma,
sarcoma; non-neoplastic sulfa, NSAIDS, PPI
- ectopic pregnancy, RA, (e.g. omeprazole),
psoriasis, IBD, vasculitis penicillins, ascorbic
acid, acidic
beverages,
aspirin
prevent organ rejection,
RA, IBD, SLE
solid tumors
(particularly testicular
and small cell lung
cancer), leukemias,
lymphomas
myeloma,
myelodysplastic
syndrome
testicular, bladder,
ovary, and lung
carcinomas
testicular, bladder,
ovary, and lung
carcinomas
relapsed or refractory
low grade or follicular
chimeric monoclonal Ab directed
CD20+, B cell NHL; first
against CD20 antigen
line alone or w/ chemo
in all CD2-+ lymphomas
Refractory Hodgkin
Lymphoma, systemic
anaplastic large cell
lymphoma
Hodgkin's Lymphoma,
testicular cancer
induces differentiation
APL
bleomycin (increased
risk of pulmonary
toxicity)
CML (chronic or
accelerated phase)
attenuates activity of
proteosome inhibitors in
multiple myeloma
Toxicity/Drug Interactions
Route of
Adminstration
Other Notes
myelosuppression
(panCYTopenia), cytarabine
syndrome (fever, myalgia, bone
pain, malaise 6-12 hrs after
admin), moderate emetic
potential/diarrhea, anal
inflammation, ocular toxicity hemorrhagic
conjunctivitis/neuro toxicity
(higher doses)
manage cytarabine
syndrome w/ corticosteroid;
risk factors: underlying renal
impairment, > 50 yr,
increase alkaline
phosphatase, pre-existing
CNS lesion, neuro checks
every day
nephrotoxicity,bone marrow
suppression, mucositis,
diarrhea, skin desquamation,
nausea/vomiting, pulmonary
fibrosis
myelosupression, GI, liver;
increased toxicity w/ allopurinol
or febuxostat
bone marrow suppression
oral
oral
chemotherapy induced
peripheral neuropathy,
autonomic, neuropathy
(conspitation), vesciant (warm),
bone marrow suppression
(vinblastine)
HL (escalated BEACOPP,
BEAM), NHL (R-EPOCH)
oral
nephrotoxicity (cisplatin)
prevent nephrotoxiity w/
amifostine (free radical
scavenger) and chloride
(saline) diuresis
subQ
oral
infusion reactions, possible
reactivation of hepatitis B, risk
of PML
peripheral neuropathy,
neutropenia, anemia
thrombocytopenia, skin rash,
fever/infusion related rxn, risk of
PML, infusion reactions, possible
reactivation of hepatitis B
infusion reactions, possible
reactivation of hepatitis B
infusion reactions, possible
reactivation of hepatitis B
pulmonary toxicity
(pneumonitis), risk of
anaphylaxis, skin
hyperpigmentation, mucositis,
minimal myelosuppression
differentiation syndrome, rash,
HA, bone pain,
hypertriglyceridemia,
hyperluekocytosis, teratogenic
SubQ