Hodgkin's Lymphoma Flashcards
why is the Ann Arbor Staging important in HL
bc it spreads continguously
what is the malignant hallmark for HL
Reed-Sternberg cells
describe the clinical behavior of HL
very heterogenous
indolent to fulminant disease
is HL curable?
yes - 80%
can irradiate the suckers
which HL has the best prognosis?
lymphnocyte predominant
10+ years median survival
whcih is the worst prognosis?
lymphocyte depleted
0.3 years median survival
is the etiology known?
nope
which virus is associated with HL
EBV about 50%
What does HL cause in advanced stage
depression of cell mediated immunity
At what age does HL occur?
bi-modal age distribution
first peak - 20
second peak - .60
What other disease is bi-modal age distribution seen in?
I dk if this is correct!
ALL –> peds is most common
usually peaks early then theres a steady incline into adulthood
what is most common presentation of Hodgkins Disease (HD)
painless enlargement of cervical and/or supraclavicular LN
What can be detected using a chest xray
anterior mediastinal mass
what are the systemic symptoms of HD
unexplained fevers, drenching night sweats, weight loss > 10% body weight
what is considered a risk factor for HD
age and the stage they are in
What are the disease characteristics of HD
UNIFOCAL in origin
Predictable spread - adjacent lymph nodes
What are the disease characteristic exceptions of HD
- retrograde spread from cervical to retroperitoneal LN –> via the thoracic duct
- spleen –> liver
- vascular invasion is rare
How do you diagnose HD?
biopsy of invovled tissue
-especially at relapse
-knowing the hx of LN in HL is important bc you need to know if its a residual/scar tissue and not new
if HL is limited disease, what treatment method do you use?
radiation therapy
if Hl is widespread/extranodal invovlement, treatment?
systemic chemo
anatomical staging is important in HL bc?
critical for making treatment decisions and it defines the limits of the disease
What is the Ann Arbor Staging?
I Single lymph node (LN region (I) or a single extranodal (localized) organ or site (IE)
II Two ore more lymph nodes on the same side of the diaphram (II) or localized involvement of an extralymphatic organ or site of the diaphragm (IIE)
III Lymph node regions on both sides of the diaphragm (III) which may also involve the spleen (IIS) or local involvement of an extralymphatic organ or site(IIIE) or both (IIISE)
IV Diffuse or disseminated involvement or one or more extralymphatic organs without associated lymph node involvement
What was the historical treatment for HL
MOPP M - Mechlorethamine O - Oncovin (Vincristine) P - Procarbazine P - Prednisone
What is the treatment regimen used now
ABVD A - Adriamycin B - Bleomycin V - Vinblastine D - Dacarbazine
What is the trend in HL treatment?
to get away from chemo
what are the reasons why ABVD is better than MOPP
MOPP is very leukemagenic – can cause leukemia in the long term
MOPP causes sterility
ABVD does the opposite of MOPP
What do you do for recurrent HL
Post XRT almost always just outside of radiation field
Post chemotherapy are systemic and are best treated with high-dose therapy and autologous PBSCT
**ADC – Brentuximab vedotin
With extensive disease and bone marrow involvement, allogeneic or MUD BMT is preferred
Lymphocyte Predom – Role of rituximab
What cell does ADC target
CD30+
What is Brentuximab vedotin MOA?
bind with CD30+ on HL cell surface –> then forms a complex with CD30 and enters into the cell –> once inside, ADC chemo component is relased and kills the cancer cell
