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NCCN > HL > Flashcards

HL Flashcards

1
Q

Typical immunophenotype for CHL:

A

CD15+, CD30+, PAX-5+ (weak)
CD3-, CD20- (majority), CD45-, CD79a-

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2
Q

Typical immunophenotype for NLPHL:

A

CD20+, CD45+, CD79a+, BCL6+, PAX-5+
CD3-, CD15-, CD30-

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3
Q

Epstein-Barr encoding region in situ hybridization (EBER-ISH)

CHL:
NLPHL:

A

CHL: EBER+/-
NLPHL: EBER-

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4
Q

In general, a DLCO threshold of ____ % is acceptable for use of bleomycin.

A

≥60%

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5
Q

TRUE OR FALSE

Routine use of growth factors is not recommended with ABVD.

A

TRUE

Routine use of growth factors is not recommended with ABVD.

Neutropenia is not a factor for delay of treatment or reduction of dose intensity with ABVD

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6
Q

If there are multifocal (________________) skeletal FDG-PET/CT lesions, marrow may be assumed to be involved.

A

Three or more

In general, bone marrow biopsies are no longer indicated

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7
Q

Unfavorable Risk Factors for Stage I–II Hodgkin Lymphoma

GHSG (German Hodgkin Study Group)

A
  • ESR >50 if A; >30 if B
  • MMR >0.33
  • # Nodal sites: >2
  • Any E lesion
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8
Q

Unfavorable Risk Factors for Stage I–II Hodgkin Lymphoma

EORTC (European Organization for Research and Treatment of Cancer)

A
  • Age ≥50
  • ESR >50 if A; >30 if B
  • MTR >0.35
  • # Nodal sites: >3
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9
Q

Unfavorable Risk Factors for Stage I–II Hodgkin Lymphoma

NCCN

A
  • ESR ≥50 or any B symptoms
  • MMR >0.33
  • # Nodal sites: >3
  • Bulky >10 cm
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10
Q

International Prognostic Score (IPS)
1 point per factor (advanced disease)

A
  • Albumin <4 g/dL
  • Hemoglobin <10.5 g/dL
  • Male
  • Age ≥45 years
  • Stage IV disease
  • Leukocytosis (white blood cell count ≥15,000/mm3)
  • Lymphocytopenia (lymphocyte count <8% of white blood cell count, and/or lymphocyte count <600/mm3)
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11
Q

Primary treatment for Stage IA/IIA Favorable (Non-bulky) CHL Initial

A

ABVD x 2 cycles (category 1)

Restage with FDGPET/ CT

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12
Q

Primary treatment for Stage IA/IIA Favorable (Non-bulky) CHL post 1st interim PET CT

A

Chemotherapy alone
* 1-2: ABVD x 4 cycles
* 3: ABVD x 2 cycles + AVD x 4 cycles

Combined modality therapy
* 1-3: ABVD x 2 cycles + ISRT
* 1-2: ABVD x 3 cycles + ISRT
* 3: ABVD x 4 cycles + ISRT
* 4-5: ABVD x 4 cycles + ISRT

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13
Q

Consider PFTs after ____ cycles of ABVD.

A

4 cycles

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14
Q

Primary treatment for I-II Unfavorable (B-symptoms or bulky mediastinal disease or >10 cm adenopathy)

A

Chemotherapy alone’
* 1-3: ABVD x 2 cycles + AVD x 4 cycles
* 4-5: ABVD x 2 cycles + escalated BEACOPP x 4 cycles

Combined modality therapy
* 1-3: ABVD x 4 cycles + ISRT
* 4-5: ABVD x 2 cycles + escalated BEACOPP x 2 cycles + ISRT

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15
Q

Primary treatment for Stage III–IV

A

ABVD
* 1-3: ABVD x 2 cycles + AVD x 4 cycles
* 4-5: ABVD x 2 cycles + escalated BEACOPP x 4 cycles OR ABVD x 2 cycles + escalated BEACOPP x 4 cycles + ISRT

BV-AVD
* 1-5: Brentuximab vedotin + AVD x 6 cycles

BrECADD
* 1-3: BrECADD x 4 cycles OR BrECADD x 4 cycles + ISRT
* 4-5: BrECADD x 6 cycles OR BrECADD x 6 cycles + ISRT

Nivolumab +AVD
* Nivolumab + AVD x 6 cycles

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16
Q

Regimen contraindicated in those with neuropathy

A

Brentuximab vedotin (BV) + AVD

17
Q

Clinical Trial for BV + AVD

A

ECHELON-1

18
Q

Clinical Trial for Nivolumab

A

SWOG S1826

19
Q

Characteristics of CHL in older patients

A
  • B symptoms
  • Poor performance status
  • Mixed cellularity histologic subtype
  • EBV+ disease
  • Medical comorbidities are more frequent
20
Q

Regimens for Adults Age >60 Years or Adults With Poor Performance Status or Substantial Comorbidities

A

Stage I–II Favorable Disease
* A(B)VD (2 cycles) ± AVD (2 cycles) + ISRT (preferred)
* CHOP (4 cycles) + ISRT

Stage I–II Unfavorable or Stage III–IV Disease
* * A(B)VD (2 cycles) followed by AVD (4 cycles), if FDG-PET scan is negative after 2 cycles of ABVD.
* BV followed by AVD, conditionally followed by BV in patients with CR or PR and no neuropathy
* CHOP (6 cycles) ± ISRT

Bleomycin should be used with caution as it may not be tolerated in patients >60 years, and it should not be used beyond 2 cycles.

21
Q

Regimens for: Patients with Low EF

A

BV-DTIC (dacarbazine)

Add dexrazoxane to ABVD or CHOP, with close cardiology follow-up

22
Q

In times of vinblastine shortage, consider capping the dose at ____ mg to avoid wasting a vial.

A

10 mg

Consideration can also be made for substituting vinblastine with vincristine 1 mg.

In times of both vinblastine and dacarbazine shortage, consideration can be made for substituting ABVD with CHOP temporarily.

23
Q

Radiologic staging during pregnancy

A

Single view (posteroanterior [PA]) chest X-ray with abdominal shielding and an abdominal ultrasound or MRI without gadolinium

FDG-PET and CT imaging should be avoided.

24
Q

ABVD can be safely administered in the_________________ trimesters with excellent maternal and fetal outcomes.

A

Second and third trimesters

25
Q

TREATMENT APPROACH BY GESTATIONAL AGE

First Trimester

A
  • If asymptomatic or minimally symptomatic: delay treatment with close observation until second or third trimester
  • If severe symptoms or organ compromise: consider referral to center with expertise, consider pregnancy termination and urgent treatment, or single-agent vinblastine followed by ABVD after end of first trimester
26
Q

TREATMENT APPROACH BY GESTATIONAL AGE

Second or Third Trimester

A
  • If asymptomatic or minimally symptomatic: delay treatment with close observation until after delivery
  • If severe symptoms or organ compromise: treat with ABVD; work with high-risk obstetrics to avoid delivery while at nadir
27
Q

NLPHL

Characteristics of high risk for initial or later transformation to large cell lymphoma

A
  • Bulky disease
  • Subdiaphragmatic disease
  • Splenic involvement
28
Q

NLPHL

Primary treatment: Stage IA, IIA (Non-bulky)

A
  • ISRT (preferred or stage IA orcontiguous stage IIA)
  • Observe (stage IA patients with a completely
    excised solitary lymph node.)
29
Q

NLPHL

Primary treatment: Stage IB, IIB or Stage IA (Bulky)/Stage IIA (Bulky or noncontiguous)

A

Chemotherapy + Rituximab + ISRT
* ABVD/Rituximab + ISRT
* CHOP/Rituximab + ISRT
* CVP/Rituximab + ISRT

Rituximab

30
Q

NLPHL

Primary treatment: Stage III–IV

A
  • Observe, if asymptomatic
  • Chemotherapy + Rituximab + ISRT
  • Rituximab
  • Local RT (palliation of locally symptomatic disease)
31
Q

Complete response (CR) should be documented including reversion of FDG-PET/CT to “negative” within ____ months following completion of therapy.

A

3 months

32
Q

Patients with 2 or more of the following risk factors are considered to be at high risk for relapse:

A
  • Remission duration <1 year
  • Extranodal involvement
  • FDG-PET–positive response at time of transplant
  • B symptoms, and/or
  • > 1 second-line/subsequent therapy regimen

NCCN (13 decks)

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