LWBK1006-30 LWW-Govindan-Review December 12, 2011 19:35
430 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology ReviewAnswer 30.16. The answer is D.
Patients with paranasal sinus, testicular involvement, epidural lymphoma,
and bone marrow involvement with large cells are especially prone to
meningeal spread and should have a diagnostic lumbar puncture unless
their therapy includes agents that penetrate the cerebrospinal fluid, such
as high-dose methotrexate and leucovorin rescue. In addition, a lumbar
puncture is favored for highly aggressive large cell lymphoma in immuno-
compromised patients with HIV infections.Answer 30.17. The answer is D.
The majority of studies evaluating FDG-PET in intermediate/high-grade
NHL and HL have shown high standardized uptake value in areas of
active disease. FDG-PET is highly reliable in detecting splenic involve-
ment and has rendered laparotomy obsolete in the staging workup of
these patients. Many studies have shown the lack of reliability in detect-
ing marginal zone lymphoma, particularly the extranodal marginal type.
The available data strongly demonstrate increased sensitivity of FDG-PET
compared with the gallium scan in the staging of NHL and has supplanted
that test in the workup of patients with lymphoma.Answer 30.18. The answer is C.
SMZL accounts for up to 25% of low-grade B-cell neoplasms in splenec-
tomy samples and 1% to 2% of chronic lymphoid leukemia. The lack of
CD103 and CD25 differentiates it from hairy cell leukemia. SMZL is not
only found in the spleen but also involves the bone marrow, peripheral
blood, and unusual sites, such as the CNS (leukemic meningitis).Answer 30.19. The answer is C.
Follicular lymphoma arises from the GCBs (centrocytes and centroblasts).
Tumors are CD10+, CD20+, CD5–. Most cases are bcl-2+, and some
neoplastic cells have nuclear bcl-6. Rituxan immunotherapy has improved
all chemotherapy modalities in this disease, and radioimmunotherapy
with I131 Tositumomab (Bexxar) or Ytrium90 ibritumomab tiuxetan
(Zevalin) has produced objective responses and is currently under eval-
uation when combined with chemotherapy (CHOP) and/or autologous
stem cell transplantation. Myelodysplastic syndrome has been reported
after radioimmunotherapy and high-dose therapy and autologous stem
cell transplantation. The latter is not curative in follicular lymphoma, but
the addition of rituxan purging has improved disease-free survival and
delayed onset of relapses. Rituxan maintenance therapy has been used
in various stages of the disease, but its ultimate benefit may reside in
patients who are receiving chemotherapy for relapsing disease. Reduced-
intensity allogeneic stem cell transplantation has been successfully applied
to patients with advanced relapsed follicular lymphoma.Answer 30.20. The answer is B.
Bortezomib and the mTOR inhibitor temsirolimus have demonstrated
activity in MCL and are under evaluation in clinical trials. Bortezomib