HL

Question 1

Factors in the IPS for Hodgkins

Answer 1

“SAW MEAL”

Stage IV
Age >/= 45
WBC >/=15

Male
Erythrocytes <105
Albumin <40
Lymphocytes <0.6 or 8% of WBCs

Low Risk (0‐1) 
Intermediate Risk (2‐3)
High Risk (4‐7)

Question 2

How does nLPHL differ (from HL) with respect to:
Clinical course
Age of onset
Relationship to NHL

Answer 2

Clinical course: More indolent, less BSx, early stage disease,
LAD but not contiguous (popcorn) usually only symptom (liver, spleen, medistinal involvement rare)
DO have high relapse.

Age: Age of onset 40s. cHL bimodal peak at 20-30 and 60s.
-mostly male

Relationship to NHL Risk of transformation to aggressive NHL–>30% at 20 years

Question 3

nLPHL immunophenotype and histologic findings.

Answer 3

LP cells are typically CD20+, BLC6+, CD15-, and CD30-, CD 45+.

L&H ‘popcorn’ cells instead of Reed-Sternberg cells

Question 4

Treatment of nLPHL

Answer 4

1. Limited stage-RT

2. Advanced stage- No consensus- single agent Ritux( if frail), R-CHOP, ABVD, R-CVP, BEACOPP

Question 5

What is the molecular target of Brentuximab Vedotin?

What is the mechanism of Vedotin?

Answer 5

Microtubule disrupting agent (MMAE is the actual drug)

Antibody drug conjugate →binds to CD30, internalized and releases MMAE which binds to the tubules and disrupts the cellular microtubule network, inducing cell cycle arrest (G2/M phase) and apoptosis.

Question 6

What are two indications for immediate therapy for hypereosinophilia of unclear etiology outside of end-organ dysfunction?

Answer 6

o Very high PB eos (>100)

o Signs/symptoms or leukostasis

Question 7

What are four treatments for hypereosinophilic syndrome?

Answer 7

1. Glucocorticoids
2. Imantinib (PDGFRA/B)
3. Hydroxyurea
4. INF-alpha
5. Anti IL-5 (Mepoluzimab)
6. Alemtuzumab (anti-CD52)
7. HSCT
8. Ruxolitinib (if JAK-2 positive)
9. FGFR1- pemigatinib, sorefenib, ponatinib

Question 8

Name a drug associated with lymphadenopathy

Answer 8

Phenytoin

Question 9

Causes of death in 2 groups of echelon I study

Answer 9

ECHELON-1 trial (NEJM 2018)
o ABVD vs A+AVD for frontline cHL
o Incl: Stage III/IV cHL, previously untreated

Primary endpoint: modified PFS (death, progression, new cancer tx, non-complete response)
82.1% vs 77.2% at 24.6 months (p=0.04)

–>more neutropenia and peripheral neuropathy in Brentuximab group. More pulmonary toxicity in ABVD.

Question 10

What were the criteria for enrollment in the AETHERA trial in HL?

Answer 10

AETHERA trial (Lancet 2015)
o Do patients with unfavourable RFs pre-autoSCT benefit from maintenance BV post auto-SCT
o Incl: Primary refractory, initial remission duration of < 12 mo, or extranodal involvement at start of salvage.
o median PFS 42.9 mo for BV versus 24.1 mo for placebo.
o Most frequent AE was peripheral neuropathy, neutropenia