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Hodgkin's Lymphoma > Background and recommendations > Flashcards

Background and recommendations Flashcards

1
Q

What is considered an lymphatic organ?

A
  1. Thymus
  2. Spleen
  3. Waldeyer’s ring
  4. Appendix
  5. Peyer’s patches
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2
Q

What is the definition of bulky disease per the mediastinal mass ratio (MMR)?

A

Mass more than 1/3rd widening of the greatest thoracic width on CXR

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3
Q

For the IP scores 0, 1, 2 what are the associated 5 year PF survivals?

A

0 - 84%
1 - 77%
2- 67%

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4
Q

What are the NCCN designated negative factors for Stage I to II patients?

A
  1. B symptoms present or ESR > 50
  2. MMR > 1/3 or any mass more than 10 cm
  3. More than 3 nodal sites
  4. 2 or more extralymphatic sites
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5
Q

What are NCIC designated negative factors for Stage I to II?

A
  1. Age 40 or more
  2. MC or LD
  3. B symptoms present or ESR > 50
  4. MMR > 1/3rd or any mass > 10 cm
  5. More than 3 extranodal sites
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6
Q

For what stages are the IP score useful?

A

Stage III and IV

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7
Q

What are the constituents of the IP score?

A
  1. Male
  2. Age > 45
  3. Stage IV
  4. Hemoglobin < 10.5
  5. < 4 g/dl
  6. Lymphocytes < 600/ml or 15K
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8
Q

For the IP scores 3, 4, 5+ what are the associated 5 year PF survivals?

A

3 - 60%
4 - 51%
5+ 42%

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9
Q

What are GHSG designated negative factors for Stage I to II?

A
  1. ESR > 50 if A or ESR > 30 if B
  2. MMR > .33
  3. Any extralymphatic site
  4. More than 2 nodal sites
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10
Q

Deauville 1-3 PET/CT response criteria

A

Uptake at the primary site is less than or equal to that of the liver

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11
Q

Deauville 4 PET/CT response criteria

A

Uptake at the primary site is moderately increased compared to the liver

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12
Q

Deauville 5a PET/CT response criteria

A

Uptake at the primary site is markedly increased compared to the liver

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13
Q

Deaville 5b PET/CT response criteria

A

New sites of disease are evident

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14
Q

Stanford V regimen

A
  1. Doxorubicin
  2. Vinblastine
  3. Mechlorethamine
  4. Etoposide
  5. Vincristine
  6. Bleomycin
  7. Prednisone

Add VEP and switched out dacarbazine

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15
Q

What is ABVD?

A
  1. Doxorubicin
  2. Bleomycin
  3. Vinblastine
  4. Dacarbazine
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16
Q

What is escalated BEACOPP?

A
  1. Bleomycin
  2. Doxorubibin
  3. Procarbazine
  4. Vincristine
  5. Etoposide
  6. Prednisone
  7. Cytoxan

Got rid of V, switched out dacarbazine, added VEPC

17
Q

What are the GHSG unfavorable risk factors?

A

ESR > 50 if A, or > 30 if B
MMR > 0.33
Nodal sites > 2
E lesion any

18
Q

What are the EORTC unfavorable risk factors?

A

Age 50 or older
ESR > 50 if A, > 30 if B
MTR > 0.35
>3 nodal sites

19
Q

What stages are the Unfavorable risk factors helpful for?

A

Stage I to II

20
Q

Treatment recommendation for patient with Stage IA to IIA Nodular lymphocyte predominant HL?

A
  1. Observe if complete resection has been performed

2. ISRT to 30.6 Gy at 1.8 Gy/fx

21
Q

Treatment recommendation for patient with Stage IB to IIB or bulky Nodular lymphocyte predominant HL?

A
  1. Chemotherapy + ISRT
22
Q

What labs are needed at work up?

A 
CBC with diff
ESR
LDH
LFT
BMP
Pregnancy test for women of childnearing age
23
Q

What imaging is needed for work up?

A

PET/CT scan
Diagnostic CT of the neck, chest, abdomen and pelvis
CXR

24
Q

What tissue diagnosis is needed?

A

Excisional biopsy

BM bx for B symptoms or Stage III-IV

25
What special studies are needed up diagnosis?
MUGA scan PFTs HIV test
26
What is the recommended treatment for Stage IA-IIA, favorable?
1. ABVD for 2 cycles 2. PET/CT 3a. If Deauville 1-3 or partial response on CT, give ISRT to 20 Gy at 2 Gy/fx 3b. If Deauville 4, consider ISRT or biopsy. If negative then continue with ISRT or if positive treat with refractory disease. 3c. If Deaville 5a, biopsy and if negative give ISRT 3d. If Deaville 5b, biopsy and if negative observe with short interval follow up. If any biopsy is positive, treat that patient as if he/she has refractory disease
27
What is the recommended treatment for Stage IA-IIA, unfavorable bulky?
1. ABVD x 4 cycles and restage with PET/CT 2a. If Deauville 1-3, treat with 2 more cycles of ABVD 3. ISRT 2b. If deauville 4, treat with 2 more cycles of ABVD and if now Deaville 1-3 on restaging PET/CT then ISRT
28
When do you get a follow up set of PFTs when delivering ABVD?
After the 4th cycle of bleomycin, if more is being planned
29
Deaville Score 1
No uptake beyond background
30
Deaville Score 2
Uptake at or below that of mediastinum
31
Deaville Score 3
Uptake above that of mediastinum but below at or liver
32
Deaville Score 4
Uptake moderately increased compared to liver at any site
33
Deaville Score 5
5a. Uptake markedly increased compared to liver at any site | 5b. no metastatic sites
34
What is recommended treatment for Stage III-IV?
1. ABVD x 2 cycles then restage with PET/CT scan 2. If deauville 1-3 then give 4 more cycles 3a. If CR, observe or give ISRT to initially bulky sites 4a. If PR, give ISRT
35
What is the follow up after treatment?
H&P every 4 months for 2 years with CBC, BMP and ESR if initially elevated CT chest/abdomen/pelvis every 6 months for 2 years After 2 year, do H&P every 6 months until year three when follow up becomes yearly. Continue to order labs. No imaging.
36
When should annual breast screening be recommended for women treated with RT?
8-10 years after treatment or at age 40, whichever comes first. Get a breast MRI and mammography for women treated with chest RT between ages 10-30.
37
What alternative treatment is available for patients with Stage III-IV disease?
Stanford V for 12 weeks and restage with PET/CT scan If Deaville 1-3, then treat with ISRT to 30 Gy to all sites initially 5 cm in size or greater. If Deaville 4 ot 5a, either treat with ISRT to 36 Gy or rebiopsy and if negative treat to ISRT to 36 Gy . If the biopsy is positive treat as if there is refractory disease.

Hodgkin's Lymphoma (4 decks)

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