Too advanced for me
CHL types + markers
CD15+, CD30+, CD20 -, CD45 -
Reed steinberg cells
Nodular Sclerosing
Mixed Cellularity
Lymphocyte Depleted
Lymphocyte Rich
Deauville Score
1 - no uptake above background
2 - Uptake < mediastinum
3 - Uptake >mediastinum but <liver
4 - moderately higher than liver
5 - markedly increased uptake OR new dx sites
MOA of pembrolizumab + side effects
What tests should be done and how often?
Monoclonal ab binds to PD-1 and blocks PD-L1 and PD-L2
Immune related adverse events
TSH q6wks
This study demonstrated OS benefit in patients treated with ABVD over AVD following negative PET-2
What is RATHL -- ok to drop Bleomycin if post 2nd cycle PET is Deauville <3
Staging
A,B,E,S
NLPHL markers
CD20, PAX5, OCT2 and BCL6+, CD10- , CD15+/-, CD30-
Popcorn cells
IPS Score
Stage IV
>45 yrs
WBC >15
Male
Hb <10.5
Albumin <4
ALC <600 or <8%
0-3 y 5yr survival 80%
>4 5yr survival 60%
Brentuximab Vedotin MOA and side effects
Antibody drug conjugate
CD30
Peripheral neuropathy
Cytopenias
Pyrexia
T/F
N-AVD had significantly longer PFS than BV-AVD in advanced stage HL
True
2-year progression-free survival was 92% (95% CI, 89 to 94) with N+AVD, as compared with 83% (95% CI, 79 to 86) with BV+AVD
When to start ca screening in patients in remission?
10 years post treatment or age appropriate, whichever is earlier
T/F
ABVDx2 + BEACOPPx2 + 30Gy in early unfavorable HL has higher FFTF than ABVDx4 + 30Gy but not higher OS
True
Risk Stratification in early stage dx
* Only need one!
ESR >50 if A, >30 if B
MMR >.33
>2 or 3 nodal sites
Bulky
E lesion
Bleomycin MOA and toxicity - what tests do we need before therapy?
DNA cleavage?
Pulmonary fibrosis
Cutaneous rxns
Raynaud's
What is Echelon-1
BV-AVD showed improvement in mPFS (82% v 74%) and OS (94 v 89.4%) over ABVD
Regimen of choice for advanced Hodgkins in elderly
Nivo-AVD
Early Stage w/ negative PET-2
Positive PET-2
ABVDx2 (or just 20Gy per HD10)
escBEACOPP + RT
Which high risk patients qualify for BV maintenance
Relapse within 1yr of treatment, primary refractory dx, extranodal dx, B symptoms after therapy, >2 previous salvage therapies
Fertility sparing regimen
ABVD
GHSG HD10 study
Early Favorable: ABVD x 2 and 20Gy sufficient
(you can also give another ABVDx2)
T/F
Regimens containing nivolumab need GCSF support
False -- use GCSF for regimens containing BV (BrECADD, BV-AVD)
What would you give an early stage (non bulky) patient who has a Deauville 3 PET following ABVDx2
ABVDx2 (CALBG)
AVDx4 (RATHL)
What are the chances of cure if the interim PET in advanced stage HL is positive (Deauville 4-5)
30-35% BUT RATHL study showed 3-year OS: 87.8% with BEACOPP
90-95% if negative
What do BrECADD and BEACOPP stand for
BV, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone
Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, and Prednisone
GSHG HD 11 and 14 studies:
Early unfavorable OR bulky (after initial ABVDx2)
ABVDx4 + 30Gy if negative pet
ABVDx2 + escBEACOPPx2 + 30Gy if positive pet
** If PET negative after 2+2 treatment, you can drop radiation (HD17)
2nd line regimens
BV-nivolumab
Pembro-ICE
Nivo --> NICE
Pembro-GVD