Classic Hodgkin Lymphoma

Question 1

What is the peak age of Hodgkin Lymphoma?

Answer 1

20-30 yo
>70 yr old

Question 2

See Slide 36

Answer 2

This is how you stage classic Hodgkin lympoma

Question 3

How do you assess the response in hodgkin lymphoma?

Answer 3

Question 4

What are the example treatment courses for Lymphoma?

Answer 4

Question 5

What did the studies for removing bleomycin show?

Answer 5

You can safely remove bleomycin if PET negative after 2 cycles.

Question 6

What is ABVD Chemo therapy for Hodgkin Lymphoma?

Answer 6

A: Anthracycle: Doxorubicin (25 mg/m3)
B: Bleomycin (10 units/M2)
V: Vinblastine (6 mg/m2)
D:Dacarbazine (375 mg/m2)

Day 1 and 15

Question 7

What is BV-AVD?

Answer 7

BV: Brentuximab Vedotin (1.2 mg/kg)
A: Doxorubicin
V: Vinblastine
D: Dacarbazine

Also give Growth Factor
Day 1 and 15

Question 7

What is N-AVD?

Answer 7

N: Nivolumab –> 240 mg
A: Anthracycline (Doxorubicin) –> 25 mg/m2
V: Vinblastine —> 6 mg/m2
D: Dacarbazine –> 375 mg/m2

Day 1 and 15

Question 8

Should you delay or dose adjust ABVD treatment if a patient is neutropenic?

Answer 8

Guidelines say no.

Question 9

What is BrECADD?

Answer 9

Br: Brentuximab Vedotin —> 1.8 mg/kg (Day 1)
E: Etoposide 150 mg/m2 (Day 2-4)
C: Cyclophosphamide 1250 mg/m2 (Day 2)
A: Doxorubicin 40 mg/m2 (Day2)
Mesna: —> Day 2 (IV Prior infusion, 2 hours after, 6 hours after)
D: Dacarbazine 250 mg/m2 (Day 3-4)
D: Dexamethasone: 40 mg (day 2-5)

Question 10

Why is MESNA given with BrECADD?

Answer 10

Prevention of Toxicity

Question 11

What anti-infectives are given with BrECADD?

Answer 11

1. Acyclovir 400 mg PO BID
2. Levofloxacin 500 mg PO QD x 10 days
3. Fluconazole 400 mg PO QD
4. Bactrim PO MWF or BID

Question 12

What are the supportive care given with BrECADD?

Answer 12

1. Anti-infectives
2. Anti-emetics
3. Growth Factor

Question 13

What is the mechanism of action of Bleomycin?

Answer 13

Antineoplastic

Question 14

What are the side effects of Bleomycin?

Answer 14

1. Rare Hypersensitivity or Idiosyncratic Reaction
   —-> Do not give test doses
2. Dermatologic Toxicity
3. Pulmonary Toxicity

Question 15

What should you monitor prior to starting Bleomycin?

Answer 15

PFTs

Question 16

What are the risk factors for Pulmonary Toxicity with Bleomycin?

Answer 16

1. Increased Age
2. Cumulative Doses >400 units
3. Baseline Lung Dysfunction
4. Growth Factor Administration

–> Can occur after first dose to months after receiving.

Question 17

What is the mechanism of action of Vinblastine?

Answer 17

Vinka Alkalide

Question 18

What is the formulation of Vinblastine?

Answer 18

IV (No Vines in the Spine)

Question 19

What are the dose adjustments for Vinblastine?

Answer 19

Hepatic

Question 20

What are the side effects of Vinblastine?

Answer 20

1. Constipation
2. Peripheral Neuropathy
3. Jaw Pain
4. Extravasation
5. SIADH

Question 21

What is the mechanism of action of Dacarbazine?

Answer 21

Alkylating Agent –> Methylation leads to DNA double strand breaks and apoptosis.
—> Non-Cell Specific

Question 22

What are the dose adjustments for Dacarbazine?

Answer 22

Renal

Question 23

What are the side effects of Dacarbazine?

Answer 23

1. N/V
2. Bone Marrow Suppression
3. Alopecia

Question 24

What is the mechanism of Brentuximab Vedotin?

Answer 24

1. Anti CD-30 Drug Conjugate Vedotin = MMAE is an anti-microtubule Causes cell cycle arrest in G2 and M phase.

Question 25

When should Brentuximab Vedotin be administered?

Answer 25

After AVD in BV-AVD

Question 26

What medications should be given before Brentuximab Vedotin?

Answer 26

APAP, Antihistamine

Question 27

What are the side effects of Brentuximab Vedotin?

Answer 27

1. Peripheral Neuropathy 2. Bone Marrow Suppression ---> Needs growth factors 3. Infusion Reaction 4. Pulmonary Toxicity 5. Progressive Multifocal Leukoencephalopathy

Question 28

What is the mechanism of action of Nivolumab?

Answer 28

Anti-PD-1 Monoclonal Antibody

Question 29

Should you use steroids Nivolumab?

Answer 29

No!!!!

Question 30

What are the side side effects of Nivolumab?

Answer 30

1. Infusion Reactions 2.Immune Related ADEs

Question 31

What is the required supportive care for ABVD?

Answer 31

Anti-Emetic of Choice

Question 32

N-AVD Supportive Care

Answer 32

Anti-emetic of Choice

Question 33

BV-AVD Supportive Care

Answer 33

1. Acyclovir 400 mg PO BID 2. Anti-Emetic of Choice 3. Growth Factor

Question 34

BrECADD Supportive Care

Answer 34

1. Acyclovir 400 mg BID 2. Bactrim DS PO MWF or Po BID SAT/SUN 3. Levofloxacin 500 mg PO QD x 10 after chemotherapy 4. Fluconazole 400 mg QD 5. Dexamethasone 40 mg PO on day 4 6. Mesna 500 mg/m2 PO Q2H and Q6H after cyclophosphamide 6. Growth Factor

Question 35

What are our treatments in older adults?

Answer 35

Slide 48

Question 36

Relapsed or Refractory Therapy

Answer 36

Slide49