Hodgkin's Lymphoma

Question 1

ABVD

Answer 1

• Doxorubicin 25 mg/m2 IV on days 1,15
• Bleomycin 10 units/m2 IV on days 1,15
• Vinblastine 6 mg/m2 IV on days 1,15
• Dacarbazine 375 mg/m2 IV on days 1,15
• Given every 28 days

Question 2

AAVD

Answer 2

• Doxorubicin 25 mg/m2 IV on days 1,15
• Brentuximab 1.2 mg/kg IV on days 1,15
• Vinblastine 6 mg/m2 IV on days 1,15
• Dacarbazine 375 mg/m2 IV on days 1,15
• Given every 28 days

Question 3

When is AAVD preferred?

Answer 3

• Studied in Stage III/IV (advanced stage) patients
• As efficacious as ABVD
• Good for older patients, pts with pulmonary comorbidities

Question 4

brentuximab MOA

Answer 4

Brentuximab is an antibody drug conjugate, bound to MMAE

1. Binds to CD30 on surface of lymphoma cells
2. Brentuximab is taken into the cell via endocytosis
3. Lysozyme arrives
4. MMAE is cleaved from antibody
5. MMAE disrupts microtubule polymerization, cell cycle arrest and apoptosis

Question 5

doxorubicin side effects

Answer 5

• Myelosuppression
• Maximum lifetime dose due to cardiac toxicity (~ 450 mg/m2)
• Turns urine red/orange for 24-72 hours post dose (color = bright red)
• Dose adjust for liver function

Question 6

bleomycin side effects

Answer 6

• Hypersensitivity reactions:
  
  • Test dose with first cycle (?)
• Pulmonary fibrosis: (max dose 30 units/dose, or 400 units cumulative lifetime dose)
• Mucositis
• Flu-like symptoms

Question 7

brentuximab vedotin side effects

Answer 7

• Peripheral neuropathy
• Myelosuppression

Question 8

vinblastine side effects

Answer 8

• Myelosuppression
• Mucositis
• Neurotoxicity (but not dose limiting like vincristine)
• Dose adjust for liver function

Question 9

dacarbazine side effects

Answer 9

• Myelosuppression
• Nausea and vomiting (highly-emetogenic)
• Photosensitive (protect from light, pink color = drug has oxidized)

Question 10

N/V patient education

Answer 10

• Regimen considered highly emetogenic (dacarbazine!)
• NK1 + 5HT3 antagonist + corticosteroid with each dose of chemotherapy
• Advise patients to take PRN anti-nausea meds and f/u with patients when they come in for the next round of treatment
• Small frequent meals, stay hydrated (don’t “tough it out”)

Question 11

FN patient education

Answer 11

• Neutropenia PLUS a single oral temperature of ≥ 38.3°C (100.4°F)
  
  • Should have a reliable oral thermometer at home
• Counsel patients on what to do in the presence of a fever
  
  • Go to nearest emergency room if after-hours
• Rates higher with AAVD over ABVD

Question 12

INFXN patient education

Answer 12

• Growth factor support (i.e. pegfilgrastim) optional
  
  • Some evidence suggesting increased risk of pneumonitis when pegfilgrastim is given after bleomycin
• Limit “sick contact” exposures to 30 minutes or less
• No litter box duty or poop scooping
  
  • If necessary, advise to wear gloves and wash hands
• Wash all fruits and vegetables prior to consumption, no raw meat (i.e. sushi)

Question 13

What is first-line treatment regimen for HL?

Answer 13

ABVD x 2 cycles, then AVD (drop bleomcyin)

Shown to have equal efficacy to ABVD alone, but lower incidence of pulmonary toxicity

Question 14

Which medications used in HL require HDA?

Answer 14

• Doxorubicin
• Vinblastine

Question 15

Which medications used in HL have a maximum cumulative lifetime dose?

Answer 15

• Doxorubicin: 450 mg/m2 (cardiac toxicity)
• Bleomycin: max dose 30 units/dose, or 400 units cumulative lifetime dose (pulmonary toxicity)