HL

Question 1

Types of classic HL

Answer 1

Nodular sclerosis
Mixed cellularity
Lymphocyte rich
Lymphocyte depleted

Question 2

non classical HL

Answer 2

nodular lymphocyte predominant

Question 3

presence of B symp

Answer 3

40%

Question 4

sites of involvment

Answer 4

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

Question 5

Pel-Ebstein fever

Answer 5

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

Question 6

Pruritus

Answer 6

10-15%

Question 7

Less common clinical presentations

Answer 7

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

Question 8

Skin leisons

Answer 8

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

Question 9

Neurologic manifestations

Answer 9

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

Question 10

Laboratory abnormalities

Answer 10

Anemia
Hypoalbuminemia
Hypercalcemia
Leukocytosis
Thrombocytosis,
Lymphopenia
Eosinophilia

Question 11

Immunophenotype of HRS

Answer 11

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

Question 12

Cytogenetics

Answer 12

non consistant

Question 13

Molecular features

Answer 13

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

Question 14

Pretreatment blood tests

Answer 14

ESR
HBV
HCV
HIV

Question 15

Pretreatment imaging

Answer 15

PET-CT
Echo
Pulmonary function

Question 16

Bulky disease definition

Answer 16

> 10 cm
or > 1/3 of the thorax

Question 17

EORTC (for early stage)

Answer 17

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

Question 18

GHSG (for early stage)

Answer 18

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

Question 19

IPS (for advanced disease)

Answer 19

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

Question 20

EBV prognosis

Answer 20

Inferior

Question 21

Cemo+RT vs. Chemo alone for early favorable HL

Answer 21

better PFS with combined, but more toxicity

Question 22

Alternative for ABVD in early HL

Answer 22

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

Question 23

Timing of RT

Answer 23

usually 3-4 weeks after chemo ends

Question 24

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

Answer 24

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

Question 25

Amount of RT for favorable early

Answer 25

20 Gy - 30 Gy Usually 20 is enough

Question 26

When to omit bleomycin

Answer 26

Age > 80 Frailty Low probability of cure Comorbidities

Question 27

Timing of PET-CT after Tx

Answer 27

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

Question 28

BEACOPP

Answer 28

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

Question 29

BEACOPP vs ABVD for early unfavorable

Answer 29

longer PFS with BEACOPP No OS advantage More toxicity with BEACOPP

Question 30

Interim PET in early unfavorable

Answer 30

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

Question 31

CMT of early unfavorable

Answer 31

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

Question 32

CMT indication in early unfavorable

Answer 32

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

Question 33

Dose adjustments for Bleomycin

Answer 33

Pulmonary disease Renal impairment Elderly

Question 34

Tx alternatives for ABVD in advanced HL

Answer 34

BV+ AVD (Brentuximab vedotin instead od Bleomycin) BEACOPP

Question 35

indiacation for BECOPP in advanced HL

Answer 35

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

Question 36

Brentuximab vedotin mechanism

Answer 36

anti CD30 conjugated to monomethyl auristatin E

Question 37

De-escalation for advanced

Answer 37

AVD if PET2 negative after ABVD

Question 38

Acute toxicity of ABVD

Answer 38

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

Question 39

Long-term complications of ABVD

Answer 39

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

Question 40

BV+AVD vs ABVD toxicity

Answer 40

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

Question 41

Acute toxicity of BEACOPP

Answer 41

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

Question 42

Long term complications of BEACOPP

Answer 42

2nd melignancy Steriity

Question 43

Long term complications of BEACOPP

Answer 43

2nd melignancy SteriRT inity

Question 44

Tx of NLP early stage

Answer 44

FU

Question 45

Variants in NLP HL

Answer 45

A-F Based on pathology.