HL

Question 1

Hematologic Malignancies

Answer 1

Blood, bone marrow, or lymph nodes

Myeloid cell lines

Lymphoid cell lines

Question 2

What is lymphoma?

Answer 2

Lymphatic system: lymph nodes and lymph vessels

Immune system: B and T lymphocytes

Malignant transformation of lymphocytes: solid tumors of the immune system

Question 3

Hodgkin lymphoma (HL)

Answer 3

characterized by Reed-Sternberg cells

Question 4

Non-Hodgkin lymphoma (NHL)

Answer 4

30 + unique histopathologic diseases

90% are B-cells

Question 5

HL Epidemiology

Answer 5

Median age at diagnosis is 39

5-year survival rate: 88.9%

Question 6

HL pathophysiology

Answer 6

Reed-Sternberg cells: multi nucleated giant cells, originate from B lymphocytes

B-cell transcription disrupted:
-Loss of immunoglobulin expression
-Lack of apoptosis pathwats
-Proliferation of malignant cells

Question 7

HL risk factors

Answer 7

Viral exposure: EBV infection , patients > 50 yo

Impaired immune function:
-Congenital immunodeficiencies
-Solid-organ transplant
-HIV infection

Genetic factors: Ataxia telengiestasia

Question 8

HL presentation

Answer 8

B SYMPTOMS:
Fever, Drenching sweats, unintentional weight loss

Question 9

HL diagnosis

Answer 9

Biopsy: excisional biopsy

CT or PET scan

Bone marrow biopsy in advanced stage disease

Question 10

Staging

Answer 10

Early-stage favorable: Stage I-II without unfavorable factors

Early-stage unfavorable: Stage I-11 with unfavorable factors

Advanced-stage: Stage III-IV

Question 11

Unfavorable Factors

Answer 11

Large mediastinal adenopathy

B symptoms

Multiple involve nodal regions

Elevated ESR

Question 12

HL Treatment

Answer 12

Goal: CURE while minimizing toxicities and long-term complications

Modalities: Combination chemotherapy, Radiation, Autologous stem cells transplant

Question 13

ABVD

Answer 13

Doxorubicin (Adriamycin)
Bleomycin
Vinblastine
Dacarbazine

On days 1, 15 every 28 days

Toxicities: Pulmonary, Cardiotoxicity

Stage I or II x 4 cycles

Stage II or IV x 6 cycles

Question 14

AAVD

Answer 14

Doxorubicin
Brentuximab
Vinblastine
Dacarbazine

On days 1,15 every 28 days

Toxicities: Cardiotoxicity, neuropathy, myelosuppression

Do not give GSF with AAVD

Question 15

Relapsed HL

Answer 15

Early relapse: less than 1 year after treatment

High dose chemotherapy with autologous stem cell rescue

Maintenance: if high risk of relapse with brentuximab vedotin following stem cell transplant