Hodgkin Lymphoma

Question 1

Compare Hodgkin lymphoma to Non-hodgkin lymphoma

Answer 1

Hodgkin:

• Localised, single group of nodes
• Contiguous spread (stage is strongest predictor of prognosis)
• many patients have relatively good prognosis
• characterised by Reed-Sternberg cells
• Bimodal distribution (young adults and >55 years)
• more common in men except for nodular sclerosing type
• associated with Epstein-Barr virus (EBV)
• consitutional signs/symptoms: low grade fever, night sweats and weight loss

Non-hodgkin lymphoma:

• multiple lymph nodes involved
• extranodal involvement common
• non-contiguous spread
• majority involve B cell, a few T cell lineage
• Can occur in children and adults
• may be associated with HIV and other auto-immune disease
• May present with constitutional signs and symptoms

Question 2

What are the symptoms of wide-spread disease for Hodgkin lymphoma (B symptoms)

Answer 2

• fever
• night sweats
• weight loss
• pruritis
• alcohol induced pain - so pain in affected nodes after drinking alcohol

Question 3

What are the pre-treatment evaluation of Hodgkin lymphoma

Answer 3

• Blood evaluation including HIV serology
• increased lactate dehydrogenase
• staging with CT neck/pelvis
• assessment of prognostic
• fertility preservation consideration

Question 4

What are the haematological/biochemical markers of Hodgkin lymphoma

Answer 4

• mild anaemia
• leukocytes with increase lymphatic count
• increase ESR & CRP because of infiltrate
• liver dysfunction if nodal involvement in the liver
• lymphopenia with advanced disease
• increased serum lactate dehydrogenase
• bone marrow involvement

Question 5

What is the staging of Hodgkin lymphoma

Answer 5

Ann Harbour staging

Stage 1 - One lymph node affected

Stage 2 - multiple lymph node affected on one side of the diaphragm

Stage 3 - multiple lymph nodes involved on both side of the diaphragm

Stage 4 - spread disease not contained in the lymph system anymore

Question 6

What are the prognostic factors for Hodgkin lymphoma

Answer 6

Hansenclever international prognostic index

• Age >45 yrs
• male
• stage IV disease
• WCC >16
• Lymphocytes <0.6
• serum albumin <40g/l

Question 7

What is the treatment for Hodgkin lymphoma

Answer 7

treatment regimen remains the same but the cycles depend on the stage of the disease

-combined modality - radiotherapy + chemotherapy

in favourable disease - 3x ABVD

in early unfavourable disease - 4x ABVD

in advanced disease (stages III & IV) - full course chemo

Question 8

What is the standard chemotherapy regime for Hodgkin lymphoma

Answer 8

ABVD
-Doxrubicin - cardiotoxic

• Bleomycin - hydrocortisone given prior to bleomycin because it causes infusion reaction. It is also associated with pulmonary toxicity
• Vinblastine - causes pulmonary toxicity so need to establish pulmonary function prior to treatment. can cause neuropathy and constipation so prophylaxis may be required
• Dacarbazine - photosensitive so it needs to be made in the dark

Question 9

What are the long term complications associated with Hodgkin lymphoma

Answer 9

• T cell defects
• Secondary malignancies so avoid smoking and have a healthy lifestyle
• CV disease
• Pulmonary toxicity
• Thyroid dysfucntion
• Compromised fertility

Question 10

What is Early stage disease favourable/unfavourable prognosis related to in Hodgkin lymphoma

Answer 10

• presence of mediastinal mass
• B symptoms
• ESR raised +++
• Age
• no of lymph nodes involved
• extranodal disease