Hodgkin Lymphoma Flashcards

Question

Tests and procedures for lymphoma staging ( laboratory and radiology)

Answer 1

Laboratory: FBC and bone marrow (check for marrow involvement), ESR, LFT’s, LDH, CRP Radiology: Chest x-ray: Detects enlarged lymph nodes in the chest PET scan: Positron Emission Tomography: use of low-dose radioactive glucose to measure the activity of cells in different parts of the body. Important in detecting minimal residual disease CT scan: Computerised Tomography: uses a small amount of radiation to build up a computerised image of the inside of the body MRI scan: Magnetic Resonance Imaging: uses magnetism to build up a picture of the body (good at showing up involvement in soft tissues and the CNS)

Answer 2

Patients require pre-treatment blood evaluation including HIV serology (1A). Staging with contrast–enhanced CT of the neck to pelvis is required (1A), although PET/CT is preferable if clinically feasible (1B). Early stage patients should be classified as favourable or unfavourable (1A). Advanced stage patients should be assessed to define the Hasenclever/IPS (1A). For male patients, pre-treatment semen cryopreservation should be offered where possible (1A). For female patients, pre-treatment review of options with a fertility specialist should be considered (1A).

Answer 3

EORTC, European Organisation for the Research and Treatment of Cancer; GHSG, German Hodgkin Study Group; Patient must have: Eortc features: No large mediastinal adenopathy, ESR <50 mm/hr without B sympoms. ESR< 30 mm/hr with B sympoms - age< or equal to 50 years - 1-3 lymph node sites involved GHSG features: No large mediastinal adenopathy, ESR <50 mm/hr without B sympoms. ESR< 30 mm/hr with B symptoms, no extra nodal disease, 1-2 lymph node sites involved

Answer 4

Erotc: Large mediastinal adenopathy ESR > 50 mm/hr without B symptoms ESR> 30 mm/hr with B symptoms, age of less than 50 years, age > 50 years, > or equal to 4 lyph node sites involved GHSG features: Large mediastinal adenopathy, ESR > or equal to 50 mml/hl without B symptoms, ESR> or equal to mm/he with B symptoms, extranodal disease, > or equal to 3 lymph node sires involved.

Answer 5

AKA international prognostic score 7 factors identified based on over 5000 patients who initially recieved chemotherapy: -Age >45 years - Male gender - Serum albumin < 40 g/l Hb < 105 g/l Stage 4 disease Leuococytosis ( WBC 15X10^9/L or above) Lymphopenia ( <0.6 x 10^9 or < 8% of WBC count) each factor reduced predicted 5- year freedom from progression rate by ~ 8%

Answer 6

- Dependent on stage and symptoms present - Radiotherapy: A. May be used alone for patients with more localised disease (NLPHL). B. role in the elimination of bulky disease that may remain after chemotherapy. C. to eliminate painful skeletal, nodal or soft tissue deposits after chemotherapy - Combination chemotherapy - Combined modality therapy d: chemotherapy and radiotherapy together at lower doses -Stem cell transplantation -Supportive measures

Answer 7

- Involved-site radiotherapy (ISRT) :internationally recognised as standard of care for HL treated with combined-modality therapy - dose for favourable (GHSG) early-stage disease: 20 Gy - dose for most other indications< 30 Gy, boost to 36–45 Gy may be considered for partial responses - decision to use or omit radiotherapy in early and advanced-stage HL should be made on the individual risk profile and acceptable balance between toxicity and efficacy

Answer 8

- Cyclical chemotherapy : used for stage III and IV disease and stage I and II patients who have bulky disease, B symptoms or who have relapsed following initial radiotherapy - Adriamycin, Bleomycin, Vinblastine and Dacarbazine (ABVD) most commonly used - Bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone (BEACOPP) may be useful for disease with a poor prognosis (more intensive)

Answer 9

-chemotherapy and radiotherapy are used together -allows short courses of chemotherapy to be combined with reduced levels of radiotherapy

Answer 10

Clinical examination Imaging Identification of residual masses

Answer 11

Treatment with alternative combination chemotherapy Radiotherapy for bulky disease If second line treatment fails: autologous transplant in people under 65 years of age considered

Answer 12

Standard of care for patients with early favourable disease is to start with two cycles of ABVD followed by an interim PET scan (1A). For early favourable disease and a negative interim PET scan, standard of care is a total of 2–3 cycles of ABVD followed by radiotherapy (1A). For early favourable disease and a negative interim PET scan, it may be appropriate to omit radiotherapy following discussion with a radiation oncologist. These patients should receive a total of three or four cycles of ABVD (1A).

Answer 13

For early unfavourable disease, a standard of care is two cycles of eBEACOPP and two cycles of ABVD followed by a PET. With a positive scan, patients should be offered radiotherapy (1A). -For early unfavourable disease, an alternative standard is two cycles of ABVD followed by interim PET. If iPET-negative, patients have 1–2 further cycles of ABVD with radiotherapy or complete a total of six cycles of chemotherapy with the last four being AVD without radiotherapy (1A). -For early-stage disease with a positive PET scan after two cycles of ABVD, consider two cycles of eBEACOPP followed by radiotherapy (1A). - DS1–3 is considered complete metabolic response (1B).

Answer 14

Prognosis depends on stage, age and histology results/type of HL. Stage 1 or 2 disease: 91 to 94% diagnosed with early stage Hodgkin lymphoma will live for at least 5 years. Stage 3 or 4 disease: 59 to 90% will live for at least 5 years. Even after relapse, HL can often be treated successfully again. Cure rates are slightly lower if this happens though although the disease can be kept under control for a long time. European Organization for Research and Treatment of Cancer (EORTC) – divides limited stage disease (I & II) into favourable and unfavourable groups. The International Prognostic Score (Hansclever Index) is useful for patients with advanced disease.

Answer 15

Second malignancies (lung and breast cancer are related to radiotherapy, MDS and AML are related to chemotherapy) Cardiac disease Endocrine dysfunction Intestinal problems Lung damage (usually subclinical) Psychological problems Much progress has been made in recent years in the treatment of HL The results of therapy are extremely good Attention must be paid to the late effects of treatment

Hodgkin Lymphoma Flashcards

(39 cards)