Jun 02, 2022
Test your knowledge of lymphomas and multiple myeloma with two multiple-choice questions from the ASCO Self-Evaluation Program (ASCO-SEP) on ASCO Education.
ASCO seeks to advance the education of all oncology professionals and ultimately facilitate and support enhanced patient care. The ASCO Oncology Self-Assessment Series on ASCO Connection consists of free case-based multiple-choice practice questions, educational links, and answer rationales from ASCO-SEP. Learn more about ASCO’s Educational products such as the new 2022 ASCO-SEP Digital Edition plus Question Bank for oncology trainees and Training Program Directors; visit ASCO Education for Education Essentials for Oncology Fellows (EEOF).
Correct answers are listed at the bottom of the page.
Question 1: Lymphomas
A 62-year-old man presented to his primary care provider with a six-month history of persistent swelling, redness, and itching at the inner end of the right eye. He initially received treatment with topical antibacterial eye drops with no relief. He was then referred to an ophthalmologist. On examination, he had mild ptosis and a 2-cm pink salmon patch in the bulbar conjunctiva with no palpable adenopathy in the preauricular and neck region. An MRI of the orbit showed a 3-cm tumor in the right bulbar conjunctiva involving the retrobulbar tissue and muscles. A biopsy showed a CD20-positive and CD23-, CD5-, and CD10-negative malignant lymphoid population.
Which of the following should you recommend now?
- Involved-site radiation
- Surgical resection
Question 2: Multiple Myeloma
A 65-year-old woman with a history of standard-risk IgG kappa myeloma was found to have disease progression while on lenalidomide maintenance therapy. Her treatment history includes induction with lenalidomide, bortezomib, and dexamethasone, followed by autologous stem cell transplant and lenalidomide maintenance therapy. While on lenalidomide maintenance, M protein level rose, and a PET scan demonstrated new bone lesions. A bone marrow biopsy revealed 50% kappa-restricted plasma cells and del(17p). Creatinine level is stable at 1.5 mg/dL. Eastern Cooperative Oncology Group (ECOG) performance status is 1.
What is the most appropriate treatment option?
- Bortezomib and dexamethasone
- Lenalidomide, bortezomib, and dexamethasone
- Carfilzomib and dexamethasone
- Daratumumab, carfilzomib, and dexamethasone
Question 1 Rationale and References
Correct answer: A. Involved-site radiation
Rationale: Primary ocular adnexal marginal zone lymphoma is a low-grade indolent tumor with an excellent radiation response and nearly 100% local control, with very high 10-year relapse-free survival. In a study by Ferreri et al., doxycycline showed 66% two-year relapse-free survival in patients testing positive for Chlamydia psittacosis infection and even lower response rates in patients who tested negative. Surgery has high local failure rates and tumor recurrence if not followed by adjuvant radiation or chemotherapy, owing to tumor microinfiltration into the surrounding tissue.
- Stefanovic A, Lossos IS. Extranodal marginal zone lymphoma of the ocular adnexa. Blood. 2009;114(3):501-10. DOI: https://doi.org/10.1182/blood-2008-12-195453
- Ferreri AJ, Ponzoni M, Dognini GP, et al. Bacteria-eradicating therapy for ocular adnexal MALT lymphoma: questions for an open international prospective trial. Ann Oncol. 2006;17(11):1721-2. DOI: https://doi.org/10.1093/annonc/mdl124
Question 2 Rationale and References
Correct answer: D. Daratumumab, carfilzomib, and dexamethasone
Rationale: Triplet regimens are better than doublet in terms of response rate and progression-free survival in newly diagnosed and relapsed or refractory multiple myeloma. The combination of carfilzomib and daratumumab has shown substantial efficacy with tolerable safety in a phase 3 study. The daratumumab, carfilzomib, and dexamethasone combination significantly prolonged progression-free survival, versus the carfilzomib and dexamethasone combination in patients with relapsed or refractory multiple myeloma and was associated with a favorable risk-benefit profile.
- Dimopoulos M, Quach H, Mateos MV, et al. Carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone for patients with relapsed or refractory multiple myeloma (CANDOR): results from a randomised, multicentre, open-label, phase 3 study [published correction appears in Lancet. 2020 Aug 15;396(10249):466]. Lancet. 2020;396(10245):186-97. DOI: https://doi.org/10.1016/S0140-6736(20)30734-0