105 - Hodgkin's Lymphoma Flashcards
HL is defined as lymphoma of __ __ cells. It makes up to _% of lymphomas. High cure rate- _%
adult
B
10
85
HL is more common in __ __. Typical age at diagnosis is divided to two peaks- __ and __
white
men
20
80`
HL is classified into 4 types:
nodular sclerosis
lymphocyte rich
mixed cellularity
lymphocyte depleted
__ and __ make 95% of HL. Young patients usually have __, while HIV/elders/3rd world have more __
nodular sclerosis
mixed cellularity
nodular sclerosis
mixed cellularity
The presence of __ cells is enough to diagnose the disease.
Reed-Sternberg
Reed Sternberg cells are __ with a lot of __, __/__ nuclei. They are positive for __ and rarely express __/__. 85% will express __, and 100% express __
large cytoplasm bilobed/multi PAX5 CD19/20 CD15 CD30
Most patients with HL will present with palpable __. It will be __, usually in the __/__/__. 50% of patients will present with __ lymphadenopathy.
lymphadenopathy
unpainful
neck/axilla/supraclavicular
mediastinal
30% HL patients will show __symptoms, and __ (Pel–Ebstein fever). Rare presentation may also include lymph node pain when consuming __
B
FUO
alcohol
In order to diagnose HL- perform __ and look for tumor mass of __ cell origin with __ infiltration.
biopsy
B
inflammatory
It is important to look for comorbidities when diagnosing HL, especially __ and __, due to the treatment’s __
lung
CHF
S/E
DDx for HL includes: 4
NHL
mononucleosis
infectious process
adenopathy due to phenytoin (anti seizure)
HL staging is done with __. It is more accurate in locating __ involvement.
PET CT
BM
HL early disease early disease is- __, late disease is -__
1-2
3-4
HL stage 1:
Involvement of __ lymph node region or lymphoid structure
1
HL stage 2:
Involvement of __ lymph node region or lymphoid structure on the same side of the __
> 1
diaphragm
HL stage 3:
Involvement of lymph node region or lymphoid structure on both sides of the __
diaphragm
HL stage 4 is defined as involvement of __ sites.
extranodal
Another HL staging is to:
A- ___
B- unexplained __/__/__ during the 6 months before staging investigation
E- __/__ involvement of __ tissue excluding the __+__
asymptomatic weight loss/fever/night sweats localized/solitary extralymphatic liver/BM
IPS score is used for advanced HL, every category gives 1 point and worsen the prognosis: 7
male >45 S IV Alb < 4g/dL Hb < 10.5 g/dL WBC < 15K Lymphocytes < 600 / 8% of total weight count
HL prognosis ranges between __% without and RF, to __ with >4 RF (very rare)
88
62
HL therapy usually includes __ alone or combined with __. When it is advanced we treat with __ only
chemotherapy
radiation
chemotherapy
The commonly used regiment for chemotherapy in HL is __ (__, __, __, __)
ABVD
A – doxorubicin (Adriamycin) B – bleomycin. V – vinblastine. D – dacarbazine (DTIC)
HL cycles consists of __ treatments, given every __ week
2
2nd
Low risk HL should go through ___ cycles, without radiation.
4-6
Advanced HL should get __ cycles of chemo. Consider __, but remember it improves __ but not __, and is usually given for __ disease.
6 radiation recurrence survival bulky
Anti CD__ (__) could be benefitable for advanced HL patients when combined with __.
30
brentuximab
AVD
Recurrent HL are given __ chemotherapy- __ (__,__,__) or __ (__,__,__).
salvage
ICE (Ifosfamide, Carboplatin, Etoposide)
GNC (Gemcitabine, Navelbine, Doxorubicin)
Over __% of recurrent HL who had almost full response to salvage chemo, can be cured with __ __ __.
50
allogenic
BM
transplantation
Recurrent HL who did not respond to salvage chemotherapy may benefit from __.
radiation
Recurrent HL patients with advanced disease who did not respond to salvage chemotherapy should be given __ as bridging until __. __ inhibitors are also useful.
brentuximab
allogenic transplantation
PD1
NLPHL= __
Nodular lymphocyte-predominant Hodgkin lymphoma
NLPHL has similar characteristics to __ NHL, and may transform into __.
indolent
DLBCL
NLPHL is found mostly in __ (__%), usually in __ or __. Prognosis is usually __
men 75 childhood 30-40 good
