Hodgkin Lymphoma Flashcards
what is hodgkin lymphoma (HL)?
a haematological malignancy that arises from B lymphocytes in the lymphatic system
how does hodgkin lymphoma occur?
when B lymphocytes, derived from the germinal centres of lymphoid tissues, mutate and lead to the presence of large, multi-nucleated giant cells called ‘reed-sternberg’ cells and large, mono-nucleated cells called malignant ‘hodgkin cells’
what are the two types of hodgkin lymphoma?
- classical hodgkin lymphoma (95%)
- nodular lymphocyte-predominant hodgkin lymphoma (5%)
classical hodgkin lymphoma (cHL) is further subclassified into which types?
- nodular sclerosis
- mixed cellularity
- lymphocyte-rich
- lymphocyte-depleted
what are the risk factors for hodgkin lymphoma?
- EBV
- HIV
- immunosuppression
- non-hodgkin lymphoma (NHL)
- family history of hodgkin lymphoma (HL), non-hodgkin lymphoma (NHL) or chronic lymphocytic leukaemia (CLL)
- smoking
what is the most common symptom of HL?
a painless, rubbery, enlarged lymph node/nodes, typically in the cervical or supraclavicular region
what are the other symptoms of HL?
- B symptoms (e.g. fever, night sweats, weight loss)
- chest discomfort +/- cough/dyspnoea (e.g. mediastinal mass)
- abdominal discomfort/pain
- alcohol-induced pain at nodal sites
- pruritus
- malaise
- fatigue
what are the findings on examination of HL?
- lymphadenopathy
- hepatomegaly
- splenomegaly
- superior vena cava (SVC) syndrome (e.g. mediastinal mass)
- paraneoplastic syndrome (e.g. cerebellar degeneration)
what are the investigations for HL?
- FBC
- U&Es
- LFTs
- LDH
- ESR
- CXR (e.g. intrathoracic lymphadenopathy, mediastinal expansion)
- contrast-enhanced CT neck, chest, abdomen + pelvis
- PET-CT
- lymph node excision biopsy
what is the hallmark cell seen on light microscopy in HL?
- the reed-sternberg cell, a giant malignant multi-nucleated cell often described as ‘owl-like’
- it is typically surrounded by a collection of non-malignant immune cells
what are hodgkin cells?
giant malignant mono-nucleated cells, which tend to be present surrounding reed-sternberg cells
which antigens are positively expressed on reed-sternberg cells using immunocytochemistry?
CD15
CD30
what is the staging system used for HL?
ann arbor
due to the increased risk of opportunistic infections following chemotherapy, patients with HL are usually given which vaccinations?
- polyvalent pneumococcal vaccine
- influenza vaccine
- meningococcal group C conjugate vaccine
- haemophilus influenzae type b vaccine
what is the initial therapy for HL?
- early-stage disease (stage IA, IB, IIA) is usually treated with one or more cycles of combination chemotherapy plus radiotherapy
- advanced stage (stage IIB or above) is usually treated with a more intensive chemotherapy course; often without radiotherapy unless a particularly large mass is present
what are the most commonly used chemotherapy combination regimes in HL?
- ABVD: Doxorubicin (Adriamycin®), Bleomycin, Vinblastine and Dacarbazine
- BEACOPP: Bleomycin, Etoposide, Doxorubicin (Adriamycin®), Cyclophosphamide, Vincristine (Oncovin®), Procarbazine, Prednisolone
how is relapse managed in HL?
- high dose chemotherapy (HDCT) followed by autologous stem cell transplant (ASCT)
- if a patient cannot tolerate intensive HDCT and ASCT, then combination chemotherapy and radiotherapy is considered
what is the requirement for blood transfusions in patients with HL?
- must only receive irradiated blood products, which is a lifelong requirement
- irradiated blood products are used to reduce the risk of transfusion-associated graft-versus-host disease
