Hodgkins Lymphoma

Question 1

What is the immunohistochemistry profile of classical Hodgkinson lymphoma?

Answer 1

CD 30+, CD 15+

CD45- CD20-

Question 2

What is the immunohistochemistry profile of nodular predominant HL?

Answer 2

CD30 -, CD15-

CD45+, CD20+

Question 3

How do you treat stage 1 Nodular lymphocyte predominant HL?

Answer 3

30Gy/15# XRT alone
Or surgery
Or watch & wait

Question 4

What is castlemans disease?

Answer 4

2 variants exist: uni centric and multi centric. Characterised by nodal expansions that usually leave the structure of the underlying LN partially intact.

Unicentric disease - isolated benign lymph optimisers tube disorder of young adults, generally curable with resection. May be associated with increased risk of lymphomas or amyloiosis

Multi centric disease - associated with HIV and HHV-8. Systemic disease with generalised peripheral lymphadenopathy, hepatosplenomegaly, fevers and night sweats. Also associated with lymphomas, kaposi’s sarcoma, POeMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes - Osteosclerotic myeloma).

Question 5

What are the 5 GHSG prognostic factors for early stage HL?

How does this differ from the EORTC criteria?

Answer 5

Mediastinal bulk
>=3 nodal areas
ESR >50 with no B symptoms
ESR >30 with B symptoms
Extra nodal sites

EORTC is the same except extra nodal sites is replaced with age>50

Question 6

How would you treat an early favourable Hodgkins lymphoma?

Answer 6

2 x ABVD & 20Gy/10# IFRT

Or

If young and wanting to avoid XRT;
3x ABVD then PET
If deauville 3 or more 1 further ABVD & 30Gy IFRT
If deauville <3 no further treatment

Question 7

What are the drugs and dosage in the ABVD regimen?

Answer 7

Doxorubicin 25mg/m2 IV D1&15
Bleomycin 10000IU/m2 IV D1&15
Vinblastine 6mg/m2 IV D1&15
Dacarbazine 375mg/m2 IV D1&15

q28d

Question 8

What treatment would you recommend for Early unfavourable or advanced classical HL?

Answer 8

4 x ABVD & 30Gy/15# (if >60y or multiple comorbidities)

Or

2 x ABVD then PET (RATHL)
If deauville <=3 then 4xAVD
If deauville > 3 then 4 x BEACOPP
PET after 2 cycles BEACOPP if not in remission then treat as refractory

Question 9

Where should women aged <35y be referred if they have received mediastinal XRT?

Answer 9

For breast screening to start 8 years post XRT
Annual MRI under age 30
Annual mammography age 30-50
Standard 3 yearly screening after 50

2.7 fold increased breast cancer risk