Hodgkin Lymphoma Flashcards
What is the classic pathology finding in Hodgkin Lymphoma?
Reed-Sternberg cells surrounded by inflammation
RS cells recruit inflammatory cells, and then only make up 10% or less of the whole tumor
What two viral infections are risk factors for Hodgkin lymphoma?
EBV
HIV
Immunophenotype of Nodular lymphocyte predominant Hodgkin?
CD19+, CD20+, CD45+, Cd79a+, PAX5+, OCT2+
Cd15-, CD30-
Immunophenotype of classic Hodgkin Lymphoma
Cd15+, CD30+, PAX5 dim
Negative for CD19, CD20, BOB1, OCT2
Diagnosis:
CD15+, CD30+, PAX5 dim
CD19-, Cd20-, CD45-
Classic HL
Diagnosis: CD19+, CD20+, CD45+, CD79a+, PAX5+
d15-, Cd30-
Nodular LP HL
In staging HL, what do the A and B designations mean?
A = no constitutional symptoms
B = fevers, NS, weight loss, etc.
How do you calssify someone with bulky mediastinal disease?
Mediastinal mass:thoracic ratio >0.33
What classifies someone with UNFAVORABLE early stage HL? (5)
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
What is stage I HL?
One single site of lymphoma
What is stage II HL?
Multiple sites on one side of diaphragm
What is stage III HL?
Nodal involvement above and below diaphragm
What is stage IV HL?
Extranodal involvement
What stages are considered early stage?
I-II
What Deauville scores typically denote a remission?
1-2
(sometimes 3)
FDG uptake is more than mediastinum but equal or less than liver. Deauville?
3
FDG uptake is less than mediastinum. Deauville?
2
FDG is moderately increased compared to the liver, but is improved from baseline, no new sites of disease. Deauville?
4
What drugs are in ABVD?
Doxorubicin
Bleomycin
Vinblastine
Dacarbazine
Treatment options for early stage, favorable HL
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.
Treatment for nonbulky unfavorable early stage HL?
PET-Adapted ABVD (if non-bulky)
Patient with newly diagnosed advanced stage HL is treated with ABVD. PET after C2 shows Deauville 2. What to do?
Omit bleomycin and do AVD for 4 more cycles
What treatment regimen provides the best disease control in advanced stage HL?
Escalated BEACOPP
(Bleo, Etop, Doxo, Cyclophos, Vincristine, Procarbazine, Pred)
Significant toxicities with BEACOPP (2)
Infertility
MDS/AML
For those with advanced stage HL, which patients would benefit most from Brentuximab vedotin + AVD? (3)
Younger patients (<60)
Multiple extranodal sites
Stage IV
Treatment options for advanced stage HL? (2)
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)
N-AVD was compared to Bv-AVD. What what the PFS comparison?
N-AVD was better across subgroups
What was the treatment outcome difference between BrECADD and escBEACOPP
BrECADD improved PFS and was less toxic
What is the general treatment paradigm for R/R HL?
Salvage chemotherapy followed by autoHCT
What are examples of salvage chemotherapy regimens used in R/R HL? (4)
ICE, DHAP, GVP, GDP
What is prognostic after salvage chemotherapy for good outcomes?
PET negative CR prior to autoHCT
Treatment options for R/R HL after autoHCT? (3)
Brentuximab vedotin
Nivo
Pembro (should be done before BV)
Who is eligible for BV consolidation therapy after AutoHCT? (4)
Relapse within 1 year of frontline therapy
Extranodal disease at relapse
PET+ at time of transplant
>1 salvage therapy
How to sequence BV and Pembro in R/R HL?
Pembro first
Treatment of Stage I Nodular LP HL?
RT alone
Early stage treatment of Nodular LP HL?
R-CVP
Treatment of advanced Nodular LP HL?
R-CHOP
R-CVP
In patients with HL who received RT, how do you manage secondary cancer risk?
Mammograms yearly after mediastinal/axillary RT
(or MRI in pts <30)
Start 8-10 years after treatment or at 40 years old
Treatment for bulky favorable early stage HL? (3)
ABVD x4 + 30 Gy IF RT
BEACOPP x2 + ABVD x2 + 30 Gy ISRT
ABVD x6
Describe the PET-Adapted approach to ABVD in unfavorable early HL?
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
What type of HL is treated distinctly from classic HL and other variants? How is it treated differently?
Nodular lymphocyte predominant HL
It’s CD19 and CD20+, so Rituximab based regimens are useful
Describe the PET-adapted approach to favorable, early stage HL?
After 2C ABVD:
DS 1-2: ISRT 20 Gy OR ABVD x1 + ISRT 30 Gy OR ABVD x2C
DS 3+: BEACOPP +/- ISRT
