Hodgkin Lymphoma

Question 1

Name the 13 Ann Arbor Lymphatic Regions

Answer 1

1. Waldeyer’s ring
2. Cervical/SCV/occipital/pre-auricular (R vs L considered separate regions)
3. Infraclavicular
4. Axillary/pectoral
5. Mediastinal
6. Hilar
7. Para-Aortic
8. Spleen
9. Mesenteric
10. Iliac
11. Inguinal/femoral
12. Popliteal
13. Epitrochlear/brachial

Question 2

What lymph node regions are considered one region per the GHSG?

Answer 2

1. Cervical and infraclavicular

2. Mediastinum and hilum are considered one

Question 3

What cell surface markers are typical of classical hodgkin’s disease? What markers are typical of non-classical? What is that called?

Answer 3

CD 15 and CD30 (classical)

CD19, CD20, CD45, CD15-, CD30-

Nodular lymphocyte predominant (NLP)

Question 4

Name the 4 histologies considered classical HL?

Answer 4

1. Nodular Sclerosis
2. Mixed Cellularity
3. Lymphocyte Rich
4. Lymphocyte Depleted

Question 5

What is the most common histology of HL?

Answer 5

Nodular Scerlosis (>70%)

Question 6

What is the relative prognosis of the 4 classical subtypes of HL?

Answer 6

Lymphocyte rich > Nodular Sclerosis > Mixed Cellularity > Lymphocyte depleted

Question 7

How many HL patients present with B symptoms?

Answer 7

1/3

Question 8

What is the typical presentation of HL?

Answer 8

Painless adenopathy

Question 9

What labs should be ordered for HL workup?

Answer 9

Pregnancy test
HIV
CBC
ESR
Albumin
BMP
LFTs
LDH
PFTs including DLCO

Question 10

What imaging should be ordered for HL?

Answer 10

CXR
PET
Echo/MUGA for chemo

Question 11

What are the indications for a bone marrow biopsy in HL?

Answer 11

PET positive bone marrow

Cytopenias

Question 12

Name the unfavorably risk factors per the GHSG? How many are there?

Answer 12

4!

1. Bulky disease (mediastinal mass-intrathoracic diabeter >0.33)
2. > 2 sites of disease
3. ESR (>50 w/o B symptoms OR >30 with B symptoms)
4. Any extranodal lesion

Question 13

Is age an unfavorable factor in GHSH?

Answer 13

No!

But…it is in EORTC (>49 yo) and NCIC (>39)

Question 14

What defines stage II by Ann Arbor (Lugano Update)?

Answer 14

> = 2 nodal regions on same side of diaphragm OR

stage I/II with limited continguous extranodal involvement

Question 15

What differentiates stage IV from stage III disease in HL?

Answer 15

Additional noncontinguous extralymphatic involvement

Remember stage III is both sides of the diaphragm

Question 16

What was the historical chemo used in HL? What does that stand for? What were the toxicities?

Answer 16

MOPP

Mechlorethamine (mustard)
Vincristine
Procarbazine
Prednisone

Severe emesis, gonadal dysfunction, secondary leukemia

Question 17

What is the standard chemo for HL with names?

Answer 17

ABVD

Adriamycin
Bleomycin
Vinblastine
Dacarbazine

Question 18

What are the anticipated toxicities of ABVD?

Answer 18

N/V, hair loss, marrow suppression. Long term cardiac and pulmonary

Question 19

What constitutes one cycle of ABVD?

Answer 19

2 infusions/month

Question 20

What chemo is the “Stanford V”?

Answer 20

Nitrogen mustard
Doxorubicin
Vinblastine
Vincristine
Bleomycin
Etoposide
Prednisone

Question 21

What intensified chemo regimen is typically used in Europe for HL?

Answer 21

BEACOPP

Bleomycin
Etoposide
Doxorubicin
Cyclophosphamide
Vincristine
Procarbazine
Prednisone

Question 22

What chemo regimens are typically used prior to stem cell transplant?

Answer 22

BEAM or CBV

BEAM: BCNU (Carmustine), etoposide, cytarabine, melphalan

CBV: Cyclophosphamide, BCNU, etoposide

Question 23

What defines a deauville 3 on PET?

Answer 23

Uptake greater or equal to mediaastinum, but less than liver

Question 24

What defines a Deauville 4 on PET?

Answer 24

Uptake moderately increased above liver at any site.