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סקירות > HL > Flashcards

HL Flashcards

1
Q

Types of classic HL

A

Nodular sclerosis
Mixed cellularity
Lymphocyte rich
Lymphocyte depleted

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2
Q

non classical HL

A

nodular lymphocyte predominant

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3
Q

presence of B symp

A

40%

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4
Q

sites of involvment

A

Neck 60-80%
Mediastinal 50-60%
Axillary 30%
Inguinal 10%
Infradiaphragmatic lymphadenopathy alone < 10%

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5
Q

Pel-Ebstein fever

A

Fever that cyclically increases and then decreases over a period of one to two weeks.
(Uncommon)

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6
Q

Pruritus

A

10-15%

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7
Q

Less common clinical presentations

A

Alcohol-associated pain
Liver disease
Intra-abdominal disease
Skin lesions-
Bone/bone marrow involvement
Neurologic
MCD

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8
Q

Skin leisons

A

Ichthyosis (fish scales), Acrokeratosis (Bazex syndrome, papules on dosum of hands/feet), urticaria, erythema multiforme, erythema nodosum, necrotizing lesions, hyperpigmentation, and skin infiltration.

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9
Q

Neurologic manifestations

A

Cerebellar degeneration
Chorea
Neuromyotonia
Limbic encephalitis
Subacute sensory neuropathy
Subacute lower motor neuropathy
Stiff person syndrome.

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10
Q

Laboratory abnormalities

A

Anemia
Hypoalbuminemia
Hypercalcemia
Leukocytosis
Thrombocytosis,
Lymphopenia
Eosinophilia

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11
Q

Immunophenotype of HRS

A

CD30, CD15
PD-L1 and PD-L2 positive
CD45 negative
CD3, CD7 negative
CD20, CD79a, and/or CD19 usually negative

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12
Q

Cytogenetics

A

non consistant

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13
Q

Molecular features

A

Ig reaarengments
beta-2 microglobuli`n
JAK1, JAK2, STAT3, STAT5B, PTPN1
gain of PDL1 and PDL2 loci

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14
Q

Pretreatment blood tests

A

ESR
HBV
HCV
HIV

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15
Q

Pretreatment imaging

A

PET-CT
Echo
Pulmonary function

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16
Q

Bulky disease definition

A

> 10 cm
or > 1/3 of the thorax

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17
Q

EORTC (for early stage)

A

Age >50
Bulky mediastinal adenopathy
ESR > 50
≥4 sites of involvement

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18
Q

GHSG (for early stage)

A

Extranodal involvement
Bulky mediastinal adenopathy
ESR > 50
≥3 sites of involvement

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19
Q

IPS (for advanced disease)

A

Albumin <4 g/dL
HB <10.5 g&
Male
age >45
Stage IV
WBC ≥15K
Lymphopenia < 600 or < 8%

20
Q

EBV prognosis

21
Q

Cemo+RT vs. Chemo alone for early favorable HL

A

better PFS with combined, but more toxicity

22
Q

Alternative for ABVD in early HL

A

Stanford V
(Mechlorethamine, doxorubicin, vinblastine, prednisone, vincristine, bleomycin, and VP-16
with weekly variance in drugs)

23
Q

Timing of RT

A

usually 3-4 weeks after chemo ends

24
Q

Number of cycles of ABVD in favorable early HL treated with combined Tx

A

2-4
PFS and OS are similar with more toxicity with four

25
Q

Amount of RT for favorable early

A

20 Gy - 30 Gy
Usually 20 is enough

26
Q

When to omit bleomycin

A

Age > 80
Frailty
Low probability of cure
Comorbidities

27
Q

Timing of PET-CT after Tx

A

Six to eight weeks after completion of chemotherapy
and
Three months after the completion of RT

28
Q

BEACOPP

A

bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone

29
Q

BEACOPP vs ABVD for early unfavorable

A

longer PFS with BEACOPP
No OS advantage
More toxicity with BEACOPP

30
Q

Interim PET in early unfavorable

A

after 2 cycles (PET2)
and then after 2 more cycles if PET2 positive (PET4)

31
Q

CMT of early unfavorable

A

4-6 cycles of chemo (usually ABVD)- depending on PET2
+
RT of 30 Gy (20 Gy is inferior)

32
Q

CMT indication in early unfavorable

A

Bulky disease
PET2 positive- 6 ABVD + RT
PET- three weeks after Chemo shows PR

33
Q

Dose adjustments for Bleomycin

A

Pulmonary disease
Renal impairment
Elderly

34
Q

Tx alternatives for ABVD in advanced HL

A

BV+ AVD (Brentuximab vedotin instead od Bleomycin)
BEACOPP

35
Q

indiacation for BECOPP in advanced HL

A

Young pts < 60
with
High risk (IPS>= 4)
if PET2 after ABVD is positive

36
Q

Brentuximab vedotin mechanism

A

anti CD30 conjugated to monomethyl auristatin E

37
Q

De-escalation for advanced

A

AVD if PET2 negative after ABVD

38
Q

Acute toxicity of ABVD

A

Neutropenia 34% usually not severe- no need for GCSF
N/V 13%
Alopecia 31%

39
Q

Long-term complications of ABVD

A

Cardiomyopathy- rarely if doxorubicin total dose < 400 mg/m2
Pulmonary txicity- Bleomycin and RT

40
Q

BV+AVD vs ABVD toxicity

A

Less pulmonary but more neuropathy (67% vs 43%) usually reversible
and
Neutropenia (11% need GCSF) with BV+AVD

41
Q

Acute toxicity of BEACOPP

A

Cytopenias
Infection 20%
N/V 20%
ALopecia 79%

42
Q

Long term complications of BEACOPP

A

2nd melignancy
Steriity

43
Q

Long term complications of BEACOPP

A

2nd melignancy
SteriRT inity

44
Q

Tx of NLP early stage

45
Q

Variants in NLP HL

A

A-F
Based on pathology.

סקירות (28 decks)

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