Hodgkins Lymphoma Flashcards
HL pathophysiology
Reed-Sternberg cell (CD15+ and CD30+) - histology 75% nodular sclerosing
HL negative prognositc factors
albumin 45yo, WBC >15k, lymphopenia <8% of WBC
HL by prognostic factors and OS
0-2: 5yr PFS 74%, 5yr OS 86%
>or equal to 3: 5yr PFS 55%, 5yr OS 70%
HL localized stage I, nonbulky II- treatment
less is more to prevent 2nd cancers: ABVD x2 + 20Gy XRT: 5yr OS 96.6% : could give just ABVD if pt can’t tolerate XRT
HL stage bulky II/III/IV - treatment
ABVD x6-8 CR 82%, 5yr OS 73% vs MOPP CR 67%, 5yr OS 66% (also better OS than Stanford V and MOPP/ABVD combo)
HL treatment - MOPP
more male sterility, more secondary malignancy (10%)
HL stage bulky II/III/IV - treatment – BEACOPP vs ABVD (std of care)
similar OS; 7 yr OS 89 vs 84% (p=0.39), Beacopp more toxic (higher heme 81 vs 43% and non-hem 19 vs 7%)
BEACOPP escalated vs std dosing
no difference in OS outcomes
HL incidence of long term TOX: ABVD vs MOPP/ABVD
cardiac (acute MI, angina, CHF) 50, infertility (female) 0 vs 20-80%, AML <1% vs 3-5%
HL relapsed - 2nd line
autoSCT 3yr EFS 53% vs std dose chemo 10%; no need for chemosensitivity testing prior to autoSCT
HL relapsed - 3rd line, post autoSCT
brentuximab CR 34%, RR 75%, duration 20.5mo
brentuximab vedotin TOX
myelosuppression, neuropathy, infusion events, pulmonary fibrosis, PML
HL relapsed - 3rd line, post alloSCT
brentuximab CR 38%, RR 50%, median PFS 7.8mo