Lymphoma

Question 1

What are the types of lymphoma?

Answer 1

• Nodular Lymphocyte Predominant HL
• Classic Hodgkin Lymphoma
  
  • Early Favourable
  • Early Unfavourable
  • Advanced
  • Relapse/Refractory
• PMBCL (Primary Mediastinal B-Cell Lymphoma)
• DLBCL
  
  • Early stage
  • Advance stage
• Indolent Lymphoma
  
  • Follicular
  • Mycosis Fungoides

Question 2

What are the Involved Site Radiotherapy guidelines?

Answer 2

• Extranodal Lymphoma (Yahalom et al, IJROBP 2015)
• Nodal NHL (Illedge et al, IJROBP 2014)
• HL (Spect et al, IJROBP 2014)
• Pediatric HL (Hodgson et al PRO 2015)
• ASTRO Hematological Meeting 2019

Question 3

What are the NCCN RT dose constraints for HL?

Answer 3

• Heart/LV mean dose < 8 Gy (recommended), < 15 Gy acceptable
• Coronary vessels avoid hot spot
• Lung - mean dose < 13.5Gy, V20 < 30%
• Oral cavity < 11 Gy
• Parotid gland ipsilateral, Mean < 11 Gy recommended
• Breast minimise V4

Question 4

What are the basic work ups for lymphoma?

Answer 4

Work Up
- Imaging PET/CT, CT with contrast, CXR (HL)
- Ann Arbor Stage, # of involved sites (HL), bulky disease
- Bone marrow biopsy - Indolent lymphoma
- Blood work
- Additional tests - MUGA/Echo (Antracyclines), PFTs - Bleomycin

Question 5

What are the B symptoms?

Answer 5

Fevers > 38
Drenching night sweats
10% weight loss over the last 6 months

They are not: chills, pruritus, pain with alcohol consumption

Question 6

What is the classical histopathological feature for Nodular lymphocyte predominant HL?

Answer 6

“Popcorn cell” - Reedstenberg cell
CD20+
CD30-

Question 7

What is the general recommendation for the management of Stage 1A, Nodular Lymphocyte predominant HL?

Answer 7

Treatment - 30Gy ISRT

Question 8

What is shown in ILROG - Binkley et al Blood 2020?

Answer 8

For stage 1, Nodular lymphocyte predominant HL, 20 year OS is 60% is similar to combined modality therapy.
For stage 2, RT only OS is 35% at 20 years vs 55% for combined modality