hodgkins Flashcards
Hodgkins incidence
9600 annual, 1000 deaths
AIDS associated HL
extranodal, more aggressive, poor outcome
HL exposures
wood worker, carpenter, farmer, meet processor
HL path
large lymphoblasts with non-neoplastic inflammatory component
HL subtypes
classical v. nodular lymphocyte predominent
HL surface antigens
CD15+CD30+, CD20-CD79a-CD45-, PAX5+ in 90%, rearranged Ig in 90%
does HL make Ab?
No. have rearranged BCR but not expressed due to lack of transcription factor Oxt2
classical HL subtypes
similar management: nodular sclerosis, mixed cell, lymphocyte rich, lymphocyte deplete
nodular sclerosing HL
majority of classical HL, mediastinal mass
mixed cellularity HL
more in men, EBV DNA in 60%, disseminated disease and aggressive but can be curable
lymphocyte rich HL
can be CD20+, older males, often mediastinal mass, often early stage
lymphocyte deplete HL
older men or HIV+, abdominal LAD, spleen + marrow involvement.
nodular lymphocyte prdominant HL
large popcorn lymphocytic cells, CD20+, CD79a+, CD45+, CD15-, CD30-. In young man, early stage, long survival but frequent relapses.
workup of HL
CT chest/abdomen and PET/CT. BM not needed if PET/CT obtained
Staging of HL
Ann Arbor I-one LN region or lymph structure II- 2 or more, one side; 3- two or more, both sides; 4- disseminated of a deep, visceral organ
A v. B staging HL
B: 38.0 on 2+ occasions unrelated to ifn, 10%+ wt loss within 6 months, or drenching night sweats
Adverse prognostic factors
each factor reduces 5yr FFP by 8% from 84%: >45; male; SIV; alb15
best predictor of recurrence
PET non-CR after 2 cycles AVBD
HL stage IA/IIA favorable treatment
either 2 cycles AVBD + 20 gy RT, or 6 cycles AVBD with no RT
HL stage IA/IIA unfavorable treatment
unfavorable: >10cm or >1/3 transthoracic diameter; ESR>50, 3+ sites, B-symptoms, or extranodal. Treat with 4 cycles AVBD + 30 Gy RT
stage III/IV HL treatment
COPP-ABVD (cyclophos, vincristine, procarb, pred) + adrea/bleo/vinblast/dacarb) or BEACOPP
stage III/IV HL treatment age >65
NO BEACOPP. only COPP-ABVD
second line HL treatments
ICE, gem-based, or chlorambucil/vinblastine/procarb/pred
standard for relapsed HL
chemo followed by autoSCT
brentuximab for HL
anti-CD3+auristatin. give post-SCT relapse. increased risk of pulmonary tox if given with bleomycin
residual masses in HL
biopsy first if within radiation field. may get bigger for up to 6 months.
NLHPL treatment
stage I/II- RT alone or 2 ABVD + RT,
late relapses in NLHPL
RT alone, single-agent rituximab, or ABVD
stage IV NLHPL treatment
treat like classical HL +/- rituximab
