hodgkins

Question 1

Hodgkins incidence

Answer 1

9600 annual, 1000 deaths

Question 2

AIDS associated HL

Answer 2

extranodal, more aggressive, poor outcome

Question 3

HL exposures

Answer 3

wood worker, carpenter, farmer, meet processor

Question 4

HL path

Answer 4

large lymphoblasts with non-neoplastic inflammatory component

Question 5

HL subtypes

Answer 5

classical v. nodular lymphocyte predominent

Question 6

HL surface antigens

Answer 6

CD15+CD30+, CD20-CD79a-CD45-, PAX5+ in 90%, rearranged Ig in 90%

Question 7

does HL make Ab?

Answer 7

No. have rearranged BCR but not expressed due to lack of transcription factor Oxt2

Question 8

classical HL subtypes

Answer 8

similar management: nodular sclerosis, mixed cell, lymphocyte rich, lymphocyte deplete

Question 9

nodular sclerosing HL

Answer 9

majority of classical HL, mediastinal mass

Question 10

mixed cellularity HL

Answer 10

more in men, EBV DNA in 60%, disseminated disease and aggressive but can be curable

Question 11

lymphocyte rich HL

Answer 11

can be CD20+, older males, often mediastinal mass, often early stage

Question 12

lymphocyte deplete HL

Answer 12

older men or HIV+, abdominal LAD, spleen + marrow involvement.

Question 13

nodular lymphocyte prdominant HL

Answer 13

large popcorn lymphocytic cells, CD20+, CD79a+, CD45+, CD15-, CD30-. In young man, early stage, long survival but frequent relapses.

Question 14

workup of HL

Answer 14

CT chest/abdomen and PET/CT. BM not needed if PET/CT obtained

Question 15

Staging of HL

Answer 15

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

Question 16

A v. B staging HL

Answer 16

B: 38.0 on 2+ occasions unrelated to ifn, 10%+ wt loss within 6 months, or drenching night sweats

Question 17

Adverse prognostic factors

Answer 17

each factor reduces 5yr FFP by 8% from 84%: >45; male; SIV; alb15

Question 18

best predictor of recurrence

Answer 18

PET non-CR after 2 cycles AVBD

Question 19

HL stage IA/IIA favorable treatment

Answer 19

either 2 cycles AVBD + 20 gy RT, or 6 cycles AVBD with no RT

Question 20

HL stage IA/IIA unfavorable treatment

Answer 20

unfavorable: >10cm or >1/3 transthoracic diameter; ESR>50, 3+ sites, B-symptoms, or extranodal. Treat with 4 cycles AVBD + 30 Gy RT

Question 21

stage III/IV HL treatment

Answer 21

COPP-ABVD (cyclophos, vincristine, procarb, pred) + adrea/bleo/vinblast/dacarb) or BEACOPP

Question 22

stage III/IV HL treatment age >65

Answer 22

NO BEACOPP. only COPP-ABVD

Question 23

second line HL treatments

Answer 23

ICE, gem-based, or chlorambucil/vinblastine/procarb/pred

Question 24

standard for relapsed HL

Answer 24

chemo followed by autoSCT

Question 25

brentuximab for HL

Answer 25

anti-CD3+auristatin. give post-SCT relapse. increased risk of pulmonary tox if given with bleomycin

Question 26

residual masses in HL

Answer 26

biopsy first if within radiation field. may get bigger for up to 6 months.

Question 27

NLHPL treatment

Answer 27

stage I/II- RT alone or 2 ABVD + RT,

Question 28

late relapses in NLHPL

Answer 28

RT alone, single-agent rituximab, or ABVD

Question 29

stage IV NLHPL treatment

Answer 29

treat like classical HL +/- rituximab