Hodgkin's

Question 1

Hodgkin’s workup for pregnant patient

Answer 1

MRI for staging

Question 2

1) Management of HL during pregnancy
2) Management of HL diagnosed in second and third trimesters

Answer 2

• in general, delay therapy until second trimester (risks to fetus are greatest during the first trimester)
  *Unless symptomatic, bulky, progressive HL
• IF limited stage diagnosed during second trimester, ABVD
• IF diagnosed during third trimester, defer treatment until after delivery (unless aggressive)
  *Radiation is teratogenic and should be deferred until 2nd or 3rd trimester
  *Elective termination of pregnancy is rarely medically indicated

Question 3

RF’s for HL

Answer 3

• autoimmune disease
• viral infections: HIV, EBV
• immunosuppression

Question 4

Immunophenotype of classic HL

Answer 4

CD15+, CD30+

Question 5

Appearance of Reed Sternberg cell

Answer 5

Large, binucleated cell
*see photo online, owl eye

Question 6

HL subtype associated with Reed Sternberg cell

Answer 6

classical HL

Question 7

Nodular lymphocyte predominant HL immunophenotype

Answer 7

• opposite of classical HL
• CD15-, CD30-, CD20+

Question 8

Nodular lymphocyte predominant HL cell on path

Answer 8

Popcorn cells
*see photo online

Question 9

Prognosticating score in HL

Answer 9

IPS

Question 10

IPS scoring

Answer 10

SAWMEAL - 1 point for each
S - stage IV
A - age >45
W - WBC >15k
M - male
E - erythrocytes (hgb <10.5)
A - albumin <4
L - lymphocyte count <600 or <8% of WBC

Question 11

SIgnificance of letters next stage in HL (A,B,E,S)

Answer 11

A = no B symptoms
B = B symptoms
E = extranodal extension
S = spleen involved

Question 12

Relapsed HL management

Answer 12

IF late relapse, repeat chemo
IF early relapse, salvage chemo w/ auto-HSCT followed by BV maintenance

Question 13

Nodular lymphocyte predominant - 1) presentation 2) disease biology

Answer 13

1) asymptomatic LAD most commonly
2) more indolent

Question 14

Nodular lymphocyte predominant management

Answer 14

• Observe Stage I and II if asymptomatic
• *Rituxan (since CD20+) + ABVD for 2-4 cycles if requiring treatment

Question 15

When women need breast cancer screening after Hodgkin’s treatment

Answer 15

10 years post treatment

Question 16

New name for NLPHL

Answer 16

Nodular lymphocyte predominant B cell lymphoma

Question 17

Unfavorable features for limited stage disease

Answer 17

• mediastinal mass: thoracic ratio >0.33
• ESR >30 with b sx OR >50 without B sx
• extranodal involvement
  >3 lymph node areas

Question 18

favorable risk early stage treatment

Answer 18

2 cycles ABVD + 20 Gy radiation
OR
ABVD x 3-4 +/- ISRT (involved site RT)

Question 19

favorable risk early stage treatment

Answer 19

• ABVD x 4 + 30 Gy ISRT
• A(B)VD x 4-6 (PET2 negative)
• escBEACOPP x2, ABVD x 2 + 30 Gy ISRT

Question 20

Newest options

Answer 20

Nivo-AVD
*BrECADD x 4-6 (incorporates BV into BEACOPP)

Question 21

When is interim PET obtained in HL?

Answer 21

After 2 cycles

Question 22

Presence of fibrosis in biopsy of lymph noid positive for Hodgkin’s markers suggest what?

Answer 22

Nodular sclerosis variant

Question 23

NPHL immunophenotype

Answer 23

CD20+, CD79+, OCT+
CD15-, CD30-

Question 24

Next step after HL pt on ABVD has interim PET that is Deauville 3

Answer 24

• drop bleo for final four cycles

Question 25

Unfavorable early stage management

Answer 25

ABVDx2 **See NCCN for this step, get’s complicated PET+ ***BeACOPP escalation is listed on NCCN but more recent analysis have not shown benefit from escalation (high rate of secondary malignancies + infertility) BEACOPPescalated x4 BEACOPP-14x6 PET- AVD x 4 (RATHL)