Hodgkin's Flashcards
Hodgkin’s workup for pregnant patient
MRI for staging
1) Management of HL during pregnancy
2) Management of HL diagnosed in second and third trimesters
- in general, delay therapy until second trimester (risks to fetus are greatest during the first trimester)
*Unless symptomatic, bulky, progressive HL - IF limited stage diagnosed during second trimester, ABVD
- IF diagnosed during third trimester, defer treatment until after delivery (unless aggressive)
*Radiation is teratogenic and should be deferred until 2nd or 3rd trimester
*Elective termination of pregnancy is rarely medically indicated
RF’s for HL
- autoimmune disease
- viral infections: HIV, EBV
- immunosuppression
Immunophenotype of classic HL
CD15+, CD30+
Appearance of Reed Sternberg cell
Large, binucleated cell
*see photo online, owl eye
HL subtype associated with Reed Sternberg cell
classical HL
Nodular lymphocyte predominant HL immunophenotype
- opposite of classical HL
- CD15-, CD30-, CD20+
Nodular lymphocyte predominant HL cell on path
Popcorn cells
*see photo online
Prognosticating score in HL
IPS
IPS scoring
SAWMEAL - 1 point for each
S - stage IV
A - age >45
W - WBC >15k
M - male
E - erythrocytes (hgb <10.5)
A - albumin <4
L - lymphocyte count <600 or <8% of WBC
SIgnificance of letters next stage in HL (A,B,E,S)
A = no B symptoms
B = B symptoms
E = extranodal extension
S = spleen involved
Relapsed HL management
IF late relapse, repeat chemo
IF early relapse, salvage chemo w/ auto-HSCT followed by BV maintenance
Nodular lymphocyte predominant - 1) presentation 2) disease biology
1) asymptomatic LAD most commonly
2) more indolent
Nodular lymphocyte predominant management
- Observe Stage I and II if asymptomatic
- *Rituxan (since CD20+) + ABVD for 2-4 cycles if requiring treatment
When women need breast cancer screening after Hodgkin’s treatment
10 years post treatment
New name for NLPHL
Nodular lymphocyte predominant B cell lymphoma
Unfavorable features for limited stage disease
- mediastinal mass: thoracic ratio >0.33
- ESR >30 with b sx OR >50 without B sx
- extranodal involvement
>3 lymph node areas
favorable risk early stage treatment
2 cycles ABVD + 20 Gy radiation
OR
ABVD x 3-4 +/- ISRT (involved site RT)
favorable risk early stage treatment
- ABVD x 4 + 30 Gy ISRT
- A(B)VD x 4-6 (PET2 negative)
- escBEACOPP x2, ABVD x 2 + 30 Gy ISRT
Newest options
Nivo-AVD
*BrECADD x 4-6 (incorporates BV into BEACOPP)
When is interim PET obtained in HL?
After 2 cycles
Presence of fibrosis in biopsy of lymph noid positive for Hodgkin’s markers suggest what?
Nodular sclerosis variant
NPHL immunophenotype
CD20+, CD79+, OCT+
CD15-, CD30-
Next step after HL pt on ABVD has interim PET that is Deauville 3
- drop bleo for final four cycles
Unfavorable early stage management
ABVDx2
**See NCCN for this step, get’s complicated
PET+
***BeACOPP escalation is listed on NCCN but more recent analysis have not shown benefit from escalation (high rate of secondary malignancies + infertility)
BEACOPPescalated x4
BEACOPP-14x6
PET-
AVD x 4 (RATHL)
