Follicular Lymphoma
T/F it is alway necessary to do a bone marrow biopsy for follicular lymphoma
What is false? Especially if advanced disease
This is diagnostic flow cytometry (CD)
What is CD20+, CD19+, CD5+, CD23-, Cyclin D1 positive?
T/F
The STIL and BRIGHT study showed superiority of B-R over RCHOP for follicular lymphoma
What is true?
This is Ann Arbor classification of lymphoma
What's stage 1 - one lymph node, stage 2 - two lymph nodes, stage 3 - both sides of the diaphragm, 4 - extra organ involvement?
This the IHC/flow cytometry pattern for follicular lymphoma
What is
Positive for CD20 (bright), CD19, CD79a, CD10 (key marker), BCL6, BCL2 ⭐ (aberrant expression in follicles), Surface immunoglobulin (usually IgM ± IgD), Kappa or lambda light-chain restriction
Negative for CD5, CD24, cyclin D1
This is the KI 67 cut offs for high and low risk
< 10 % - low risk
> 30 % - high risk
10-30 borderline
T/F
The Gallium study showed PFS and OS benefit of Obinutuzmab vs R-chemo, but greater adverse events with Obinu
False - no overall survival benefit
This is GELF criteria indication to treat for follicular lymphoma
What is tumor > 7 cm or 3 lymph nodes > 3 cm, splenic enlargement, organ compression, ascites, pleural effusions, cytopenias B symptoms, leukemia phase, and elevated LDH/B2?
This is the treatment for stage I and II follicular lymphoma
What is Observation vs ISRT vs Rituximab?
This is the treatment for limited stage mantel cell lymphoma
What is observation or involved field radiation?
The PRIMA study showed this benefit in PFS and OS with rituximab maintenance in patients with follicular lymphoma
What is improved PFS, but not OS?
These are poor prognostic features mantle cell lymphoma
What is blastoid or plemorphic morphology, high KI67, tP53, SOX11+
What is the treatment of stage III/IV follicular lymphoma?
Low burden/asymptomatic → observe
Low burden/symptomatic → use ritux 4 doses
High burden → RB/RCHOP, R-CVP, R^2, Rituximab x 4 (don’t love bc low complete remission rates, and will be older when you have to treat them again, but can give for elderly)
Bendamustine low dose = 70mg^2 on two days rather than 90mg/m2 or could do 50% reductionto 90mg/m2 just on day1
For young, fit patients - this is the standard treatment regimen for TP53 wild type
What is cytarabine based followed by autologous transplant, followed by rituximab maintenance (LIMA showed OS benefit of 3 years ritux) now adding BTK inhibitor (2 years)?
Triangle regimen - RDHAP/RCHOP alternating with ibruitnibn then transplant
Elderly Bendamustine/Rituximab x 6 cycles followed by ritux
For TP53 mutated mantle cell lymphoma, the SYMPATICO study showed that this added to venetoclax improved response rates and deeper response rates.
What is ibrutinib?
Supports chemo-free combination therapy in R/R MCL
Provides an important option for high-risk disease, especially TP53-mutant patients
These CART cells are approved for Mantle Cell Lymphoma
Brexacaptagene autoleucel (higher rates of neurotoxity)
Lisa-cel
This is relapsed disease treatment for follicular lymphoma.
Tamezostat
3rd Line -
BITE (Epcoritamab, Mosunetuzumab)
CART (Axicel, Liso-Cel, Tiso-Cel)
PIK3 inhibitor
These are R/R for mantle cell lymphoma
What are BTK inhibitors (acala/zana) if not gotten before
Pirtobrutinib
CART
R-Benda, Bortez, Lenolidamide, Venetoclax, +/- Ritux
The BOVEN study showed this regimen yielded high overall response rates (95-100$), complete response rates (80-90%) and high MRD negativity rates.
What is zanabrutinib, obinutuzumab,and venetoclax?
Deep, durable response with chemo free regimen even in TP53 mutated patients
This non covalent, small molecule inhibitor BTK inhibitor is approved for Mantle Cell Lymphoma in the relapsed setting
What is Pirtobrutinib?