Hodgkin Lymphoma

Question 1

What is the classic pathology finding in Hodgkin Lymphoma?

Answer 1

Reed-Sternberg cells surrounded by inflammation
RS cells recruit inflammatory cells, and then only make up 10% or less of the whole tumor

Question 2

What two viral infections are risk factors for Hodgkin lymphoma?

Answer 2

EBV
HIV

Question 3

Immunophenotype of Nodular lymphocyte predominant Hodgkin?

Answer 3

CD19+, CD20+, CD45+, Cd79a+, PAX5+, OCT2+
Cd15-, CD30-

Question 4

Immunophenotype of classic Hodgkin Lymphoma

Answer 4

Cd15+, CD30+, PAX5 dim
Negative for CD19, CD20, BOB1, OCT2

Question 5

Diagnosis:
CD15+, CD30+, PAX5 dim
CD19-, Cd20-, CD45-

Answer 5

Classic HL

Question 6

Diagnosis: CD19+, CD20+, CD45+, CD79a+, PAX5+
d15-, Cd30-

Answer 6

Nodular LP HL

Question 7

In staging HL, what do the A and B designations mean?

Answer 7

A = no constitutional symptoms
B = fevers, NS, weight loss, etc.

Question 8

How do you calssify someone with bulky mediastinal disease?

Answer 8

Mediastinal mass:thoracic ratio >0.33

Question 9

What classifies someone with UNFAVORABLE early stage HL? (5)

Answer 9

Any of the following:
1. age >50
2. mediastinal mass:thoracic ratio >0.33
3. ESR >3 with B symptoms or ESR >50
4. Any extranodal involvement
5. >3 involved LN areas

Question 10

What is stage I HL?

Answer 10

One single site of lymphoma

Question 11

What is stage II HL?

Answer 11

Multiple sites on one side of diaphragm

Question 12

What is stage III HL?

Answer 12

Nodal involvement above and below diaphragm

Question 13

What is stage IV HL?

Answer 13

Extranodal involvement

Question 14

What stages are considered early stage?

Answer 14

I-II

Question 15

What Deauville scores typically denote a remission?

Answer 15

1-2
(sometimes 3)

Question 16

FDG uptake is more than mediastinum but equal or less than liver. Deauville?

Answer 16

3

Question 17

FDG uptake is less than mediastinum. Deauville?

Answer 17

2

Question 18

FDG is moderately increased compared to the liver, but is improved from baseline, no new sites of disease. Deauville?

Answer 18

4

Question 19

What drugs are in ABVD?

Answer 19

Doxorubicin
Bleomycin
Vinblastine
Dacarbazine

Question 20

Treatment options for early stage, favorable HL

Answer 20

PET Adapted ABVD after 2C
If PET negative, then ISRT 20 Gy or ABVD x1C + ISRT 30 Gy
If PET DS3, then AVD 4C or ABVDx2+ 30Gy ISRT
If PET DS4, then 2C ABVD and anothher PET.

Question 21

Treatment for nonbulky unfavorable early stage HL?

Answer 21

PET-Adapted ABVD (if non-bulky)

Question 22

Patient with newly diagnosed advanced stage HL is treated with ABVD. PET after C2 shows Deauville 2. What to do?

Answer 22

Omit bleomycin and do AVD for 4 more cycles

Question 23

What treatment regimen provides the best disease control in advanced stage HL?

Answer 23

Escalated BEACOPP
(Bleo, Etop, Doxo, Cyclophos, Vincristine, Procarbazine, Pred)

Question 24

Significant toxicities with BEACOPP (2)

Answer 24

Infertility
MDS/AML

Question 25

For those with advanced stage HL, which patients would benefit most from Brentuximab vedotin + AVD? (3)

Answer 25

Younger patients (<60)
Multiple extranodal sites
Stage IV

Question 26

Treatment options for advanced stage HL? (2)

Answer 26

N-AVD (Nivolumab, Doxo, Vinblast, Dacarbazine)
BrECADD (Bv, Etop, Cyclophos, Doxo, Dacarbazine, Dex)

PET-Adapted ABVD
Bv-AVD (not as good as N-AVD but that’s a new regimen)

Question 27

N-AVD was compared to Bv-AVD. What what the PFS comparison?

Answer 27

N-AVD was better across subgroups

Question 28

What was the treatment outcome difference between BrECADD and escBEACOPP

Answer 28

BrECADD improved PFS and was less toxic

Question 29

What is the general treatment paradigm for R/R HL?

Answer 29

Salvage chemotherapy followed by autoHCT

Question 30

What are examples of salvage chemotherapy regimens used in R/R HL? (4)

Answer 30

ICE, DHAP, GVP, GDP

Question 31

What is prognostic after salvage chemotherapy for good outcomes?

Answer 31

PET negative CR prior to autoHCT

Question 32

Treatment options for R/R HL after autoHCT? (3)

Answer 32

Brentuximab vedotin
Nivo
Pembro (should be done before BV)

Question 33

Who is eligible for BV consolidation therapy after AutoHCT? (4)

Answer 33

Relapse within 1 year of frontline therapy
Extranodal disease at relapse
PET+ at time of transplant
>1 salvage therapy

Question 34

How to sequence BV and Pembro in R/R HL?

Answer 34

Pembro first

Question 35

Treatment of Stage I Nodular LP HL?

Answer 35

RT alone

Question 36

Early stage treatment of Nodular LP HL?

Answer 36

R-CVP

Question 37

Treatment of advanced Nodular LP HL?

Answer 37

R-CHOP
R-CVP

Question 38

In patients with HL who received RT, how do you manage secondary cancer risk?

Answer 38

Mammograms yearly after mediastinal/axillary RT
(or MRI in pts <30)
Start 8-10 years after treatment or at 40 years old

Question 39

Treatment for bulky favorable early stage HL? (3)

Answer 39

ABVD x4 + 30 Gy IF RT
BEACOPP x2 + ABVD x2 + 30 Gy ISRT
ABVD x6

Question 40

Describe the PET-Adapted approach to ABVD in unfavorable early HL?

Answer 40

2 cycles of ABVD - then PET.
If PET is DS 1-3, then AVD x4C is given, or ABVDx2 + ISRT 30 Gy.
If PET is DS 4-5, then escBEACOPPx2. Then another PET. If that’s DS1-3, then BEACOPPx2 or ISRT 30 Gy

Question 41

What type of HL is treated distinctly from classic HL and other variants? How is it treated differently?

Answer 41

Nodular lymphocyte predominant HL
It’s CD19 and CD20+, so Rituximab based regimens are useful

Question 42

Describe the PET-adapted approach to favorable, early stage HL?

Answer 42

After 2C ABVD:
DS 1-2: ISRT 20 Gy OR ABVD x1 + ISRT 30 Gy OR ABVD x2C

DS 3+: BEACOPP +/- ISRT