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26 Cards in this Set
- Front
- Back
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Can core needle biopsy be used for diagnosis?
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yes, if adequate for diagnosis. Excisional biopsy is preferred
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Typical immunophenotype for Classical HL?
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CD30+, CD15+ (majority); CD3-, CD45-, CD20+ (<40%).
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Typical immunophenotype for lymphocyte-predominant HL?
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CD20+, CD45+, CD3-, CD15-, CD30-.
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Essentials of H and P?
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B symptoms including alcohol intolerance, pruritis, fatigue, performance status
Examine lymphoid regions, spleen, liver |
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Labs?
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CBC with diff (inc plts)
ESR LDH, LFTs including albumin BUN, Cr Pregnancy test in women of childbearing age |
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Imaging workup?
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Per NCCN: Chest X-ray (important for determining whether or not mediastinal dz is considered bulky), CT of chest/abdomen/pelvis (doesn't need to be done if part of integrated PET CT) and PET/CT.
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When to get a BM biopsy?
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IB, IIB, and stage III-IV
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What other tests should be considered as part of workup?
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- cardiac echo to evaluate EF prior to giving doxorubicin-containing regimens
- HIV test - Counseling: fertility, smoking cessation, psychosocial |
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What about PFTs?
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PFTs (including DLCO) should be obtained if ABVD or BEACOPP are being used
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What needs to be considered if patient received splenic RT?
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vaccination (pneumococcal, H-flu, and meningococcal)
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NCCN unfavorable factors for stage I-II disease include what?
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bulky mediastinal or >10cm disease, B symptoms, ESR >50, 4 or more sites of disease
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What is Tx recommendation for Stage IA, IIA favorable classic HL?
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ABVD x 4 Cycles followed by IFRT
(exceptions: - 2 cycles can be considered if patient fulfills strict criteria of GHSG with only 2 sites of disease and no extralymphatic lesions. - Pts with elevated ESR or > 3 sites of disease may be managed with Stanford V per this algorithm. - ABVD alone may be considered (cat 2B evidence. recommendation for IFRT is cat 1) |
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What is treatment for favorable stage IA - IIA HL in patients who cannot tolerate chemo?
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STLI (cat 1) or mantle alone may be considered
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if giving ABVD alone, how many cycles?
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can be 4 if CR after 2 cycles. but 6 if only PR after 2 cycles.
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Can we omit RT in stage I-II unfavorable bulky?
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Nope.
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What dose of RT in nonbulky stage I-II?
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20-30 Gy if treated with ABVD. 30 Gy if treated with Stanford V
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What dose of RT in nonbulky stage IB-IIB?
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30-36Gy
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What dose of RT in stage III - IV (bulky and non-bulky)
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30-36Gy
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What RT dose for bulky disease sites (all stages)?
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30-36Gy if treated with ABVD, 36 Gy if treated with Stanford V.
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When is a dose of 20Gy sufficient?
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following ABVD x 2 in nonbulky stage I-IIA disease with ESR <50, no extralymphatic lesion, and only one or two lymph node regions involved.
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NCCN unfavorable risk factors for stage I-II HD?
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ESR >50
Any B symptoms MMR (mediastinal mass ratio) > 0.33 >3 nodal sites any bulky disease (>10cm) |
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Treatment options for LPHL stage IA, IIA?
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IFRT
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Treatment options for LPHL stage IB, IIB?
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Chemo +/- IFRT
OR Rituximab +/- chemo +/- IFRT |
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Treatment options for LPHL stage IIIA, IVA
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chemo +/- RT
OR observation OR Local RT (palliation only) OR Rituximab +/- chemotherapy |
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Treatment options for LPHL stage IIIB, IVB
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chemo +/- RT
OR rituximab +/- chemo +/- RT |
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Why is follow up particularly important in LPHL?
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late relapse or transformation to large cell lymphoma may occur
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