Hodgkin's Disease (Hodgkin's Lymphoma)

Question 1

Hodgkin’s Lymphoma arises from

Answer 1

Malignant B lymphocytes

Question 2

Hodgkin vs non…age, sex, stage, mediastinal

Answer 2

Hodg - 20-40, Slight male, often low stage at presentation, Common mediastinal

Non - 50-70, slight male, depends on type, not common

Question 3

Hodgkin vs. non…BM, prognostic factors, associated immune defect

Answer 3

Hodg - Uncommon except in lymph depletion type…age, stage, B symptoms, response to initial Rx, histology?…defect in CMI common

Non - depends on type…cell type, IPI, Molecular/phenotypic profile…occasional in HMI

Question 4

Hodgkin vs. non in general

Answer 4

Hodgk - malignant lymphoma characterized by presence of Reed-Sternberg cell in the proper cellular milieu

Non - heterogenous group characterized by monoclonal neoplastic proliferation of a lymphoid cell (B or T)

Question 5

Reed Sternberg Cell markers and appearance

Answer 5

CD15, CD30
+- CD20
CD45 neg
+-EBV

Looks like owl eyes

Question 6

Incidence of Hodgkin’s

Answer 6

Peak at childhood and old age

Greater percentage of childhood cancers

Question 7

Presentation of Hodgkins

Answer 7

Persistent enlarged cervical, upper thoracic adenopathy
SOB
Facial swelling (SVC syndrome)
B symptoms - night sweats, fever, weight loss

Question 8

Nodular sclerosis

Answer 8

CD15+, CD30+, EBV-

Most common, usually stage 1 or 2…most patients young adults…M=F

Question 9

Mixed cellularity

Answer 9

CD15+, CD30+, most are EBV+

More than 50% as stage 3 or 4…biphasic incidence…M>F

Question 10

Lymphocyte rich

Answer 10

CD15+, CD30+, 40% EBV+

Uncommon, M>F…older adults

Question 11

Lymphocyte depletion

Answer 11

CD15+, CD30+, most EBV+

Uncommon, more in older males, HIV affected…presents as advanced

Question 12

Lymphocyte predominance (nLPHL)

Answer 12

Popcorn cell
CD20+, CD45+ CD15-, CD30-, EBV- (marks like a B cell)
Young males with cervical or axillary LAD, mediastinal
No R-S cells

Question 13

Lymphocyte rich classic hodgkins vs NLPHD clinical

Answer 13

Both excellent prognosis
Greater relapse in NLPHD
Better prognosis after relapse in NLPHD
NLPHD more likely to transform to non-hodgkins

Question 14

NLPHD vs. LRCHD cells

Answer 14

NLPHD - B-cell, CD15 and 30 neg, CD45, 20, and EMA positive…progress to DLBCL (diffuse large B cell lymphoma) in 3-5% of cases

LRCHD - Crippled B cell, CD15 and 30 positive…CD45 and EMA neg, +-CD20….Recurs as HD

Question 15

Lymphoma staging

Answer 15

1 - 1 lymph node or extra nodal site
2 - 2 LN regions of LN and extra nodal site on SAME SIDE of diaphragm
3 - LN’s +- extra nodular region on BOTH sides of diaphragm
4 - extra lymphatic dz

A - no “B” symptoms
B - fever+-night sweats+- weight loss

Question 16

Things that make a difference in prognosis

Answer 16

Age
Number of sites
Stage
Symptoms

Question 17

IPS for Stage 3 and 4 HD

Answer 17

Albumin<4 
Male
Hb<10.5 
Age>45
Stage 4 
Leukocytosis>15,000
Lymphocytopenia<8% WBC or <600

Question 18

Most prevalent type of HD and most deadly

Answer 18

Nodular sclerosis - most prevalent

Lymphocyte depleted is most deadly

Question 19

Therapy for HD

Answer 19

Adriamycin
Bleomycin
Vinblastine
Dacarbazine

Stanford 5, BEACOPP, radiation

Question 20

Toxicity of ABVD therapy

Answer 20

Adriamycin - cardiotoxicity
Bleomycin - pulmonary fibrosis (worse by smoking)
Vinblastine - neurotoxicity (peripheral neuropathy)
Dacarbazine - Bone marrow toxicity (cytopenic)

Question 21

Long term comps of Hodgkins tx

Answer 21

Hematologic malignancies
Solid tumors (lung and breast) from radiation
Pulmonary fibrosis (esp with GCSF)
Accelerated atherosclerosis
Hypothyroidism (especially in neck/mediastinal)