Haematological Malignancies - Hodgkins lymphoma

Question 1

What is Hodgkins lymphoma?

Answer 1

• A cancer of B cell lymphocytes, characterised by Hodgkin’s reed Sternberg cells (2 or more nuclei)
• malignant b cells lack typical b cell surface antigens
• able to evade apoptosis

Question 2

What are the symptoms of HL?

Answer 2

Fever
Weight loss
night sweats 
pruritis 
alcohol induced pain 
mediastinal involvement 
palpable hepatosplenomegaly
multiple nodules within organs 
inguinal/pelvic lymphadenopathy associated w oedema in lower limbs 
infiltration of lungs, bone marrow, skin and CNS

Question 3

What is the pre-treatment evaluation for HL?

Answer 3

Blood evaluation
staging with CT scans of neck/pelvis
Assessment of prognosis
Fertility preservation
check cardiac function (bc of anthracycline)
check respiratory history (bc of bleomycin)

Question 4

What haematological/biochemical markers are there in HL?

Answer 4

Mild anaemia
Leucocytosis with increased lymphocyte count
Raised ESR and CRP
Raised Serum lactate dehydrogenase (marker of disease activity)
LFTs = increased ALP and GGT
Lymphopenia (in advanced disease)

Question 5

What are the prognostic factors for HL?

Answer 5

Age
No. of lymph node sites involved
Presence of mediastinal mass
Increased ESR
Extranodal disease
raised lactate dehydrogenase

Question 6

What is the treatment for HL in stages 1-2, early favourable disease?

Answer 6

Short course chemotherapy (2-3 cycles) and radiotherapy

Question 7

What is the treatment for HL in early UNfavourable disease?

Answer 7

4 cycles of ABVD and radiotherapy

Question 8

What is the treatment for HL in advanced disease (stages 3-4)?

Answer 8

full course chemo (6-8 cycles) with higher dose of regimens

Escalated BEACOPP/PVACEBOP/ABVD regimen

Question 9

what is the ABVD regimen?

Answer 9

On days 1 and 15:
IV Doxorubicin 25mg/m2 (max 50mg) bolus injection via fats running drip NaCL 0.9%
IV Bleomycin 10,000 U/m2 infusion in 250ml NaCl 0.9% over 60 mins
IV Vinblastine 6mg/m2 (max 10mg) infusion in 50ml NaCl 0.9% over 10 mins
IV Dacarbazine 375mg/m2 infusion in 500ml NaCl 0/9% over at least 60 mins

repeat cycle every 28 days

Question 10

what should be prescribed if no dexamethasone is used in the anti-emetic regime?

Answer 10

IV hydrocortisone before bleomycin

Question 11

What is the standard BEACOPP regimen

Answer 11

Bleomycin 
Etoposide 
Adriamycin (Doxorubicin)
Cyclophosphamide 
Vincristine 
Procarvazine 
Prednisone
G-CSF 

repeat every 21 days

Question 12

What is the escalated BEACOPP regimen

Answer 12

Cycle repeated every 21 days with higher doses for up to 8 cycles

Question 13

What is the BEACOPP-14 regimen?

Answer 13

cycle repeated every 14 days

Question 14

What should be followed up after treatment?

Answer 14

Tx associated with long term complications:

• t cell defects
• secondary malignancies
• CVD
• pulmonary toxicity
• thyroid dysfunction
• compromised fertility

Question 15

How do B cells evade apoptosis

Answer 15

• chromosomal translocations and genetic mutations
• incorporate epstein barr virus (EBV) or latent membrane proteins (LMP 1 AND 2)
• activation of TF-NFKB
• interaction with components of microenvironment