Hodgkins Lymphoma

Question 1

HL pathophysiology

Answer 1

Reed-Sternberg cell (CD15+ and CD30+) - histology 75% nodular sclerosing

Question 2

HL negative prognositc factors

Answer 2

albumin 45yo, WBC >15k, lymphopenia <8% of WBC

Question 3

HL by prognostic factors and OS

Answer 3

0-2: 5yr PFS 74%, 5yr OS 86%

>or equal to 3: 5yr PFS 55%, 5yr OS 70%

Question 4

HL localized stage I, nonbulky II- treatment

Answer 4

less is more to prevent 2nd cancers: ABVD x2 + 20Gy XRT: 5yr OS 96.6% : could give just ABVD if pt can’t tolerate XRT

Question 5

HL stage bulky II/III/IV - treatment

Answer 5

ABVD x6-8 CR 82%, 5yr OS 73% vs MOPP CR 67%, 5yr OS 66% (also better OS than Stanford V and MOPP/ABVD combo)

Question 6

HL treatment - MOPP

Answer 6

more male sterility, more secondary malignancy (10%)

Question 7

HL stage bulky II/III/IV - treatment – BEACOPP vs ABVD (std of care)

Answer 7

similar OS; 7 yr OS 89 vs 84% (p=0.39), Beacopp more toxic (higher heme 81 vs 43% and non-hem 19 vs 7%)

Question 8

BEACOPP escalated vs std dosing

Answer 8

no difference in OS outcomes

Question 9

HL incidence of long term TOX: ABVD vs MOPP/ABVD

Answer 9

cardiac (acute MI, angina, CHF) 50, infertility (female) 0 vs 20-80%, AML <1% vs 3-5%

Question 10

HL relapsed - 2nd line

Answer 10

autoSCT 3yr EFS 53% vs std dose chemo 10%; no need for chemosensitivity testing prior to autoSCT

Question 11

HL relapsed - 3rd line, post autoSCT

Answer 11

brentuximab CR 34%, RR 75%, duration 20.5mo

Question 12

brentuximab vedotin TOX

Answer 12

myelosuppression, neuropathy, infusion events, pulmonary fibrosis, PML

Question 13

HL relapsed - 3rd line, post alloSCT

Answer 13

brentuximab CR 38%, RR 50%, median PFS 7.8mo