Diagnostic Dilemmas
These CD Markers are positive in classical Hodgkin's Lymphoma
What are CD30+/CD15+?
For early stage (stage IA/IIa), favorable risk Hodgkin's disease with initial response to ABVD x 2 cycles, these are options for consolidation.
What are radiation (preferred) or ABVD (2 additional cycles) or AVD (4 cycles total) - latter only for Deauville 3?
This was the historical standard for advanced stage (stage III/IV) Hodgkin's disease.
What are ABVD x 2 PET adapted approach and BV AVD x 6 cycles?
For PET adapted
1-3 drop bleomycin then 4 more cycles
4-5 BEACOPP x 4 more cycles
This is what BV targets
What is CD30?
This is the CD profile for Nodular Lymphocyte predominant Hodgkin's
What is CD15/30 negative, positive for CD20?
Also positive for CD45, CD79A
What is the optimal dosing of radiation used if it is used as consolidation for early stage favorable disease?
What is 20 Gy?
HD10 trial showed 20Gy equivalent to 30Gy and also 2 cycles of ABVD equivalent to 4 cycles
This is when you should add radiation.
What is bulky disease (10 cm)?
This is what BRECADD stands for.
What is BV, Etoposide, Cyclophosphamide, doxorubicin, dacarbazine, dexamethasone?
This is found under the microscope for Nodular Lymphocyte Predominant Hodgkin's lymphoma
What are "popcorn cells"?
Large cells with vesicular polylobulated nucleus and distinct peripheral nucleoli
For early stage, favorable risk Hodgkin's with interim PET scan Deauville 4-5, these are the options?
What are ABVD x 2 cycles (total 4) or biopsy if Deauville 5?
These regimens are preferred front line for stage III/IV disease
What is nivo-AVD x 6 cycles, BrECADD (4 vs 6 cycles), and BV-AVD 6 cycles?
For Stage I/II unfavorable HD who are unable to tolerate bleomycin, these are additional options
What are Nivolumab - AVD (4 cycles), BV-AVD (4 cycles) AND BrECADD (4 vs 6 cycles)?
This is the name given to large cells with bi or multinucleated containing large acidophilic nucleoli.
What are Reed Sternberg Cells?
For early stage unfavorable Hodgkin's disease with PET scan 1-3, these are the treatment options.
What are 2 more cycles of ABVD and 30 gray radiation or
AVD X 4 cycles (RATHL)
Radiation here is 30 Gy
These are treatment regimens for relapsed disease.
If < 12 months (?3 months) or primary refractory and transplant candidate --> ICE/BV/GEMOX/VD + nivolumab/pembro
Many others as well - gemcitabine based
followed by transplant
If > 12 months - can try chemo they received before or immunotherapy if they haven't before
One must give this with BV AVD and BRECADD?
What is growth factor?
These are poor prognostic factors in the IPS score?
Stage IV
Age > 45
WBC > 15k
Male
Erythrocytes - Hg b< 10.5
Albumin < 4.0
Lymphocyte < 600 or 8% of total white count
For early stage unfavorable Hodgkin's disease with PET scan 4-5, these are the treatment options.
ABVD X 2 (total 4) or escalate to BrECADD x 2 cycles
This is a maintenance option after transplant.
What is BV?
T/F ABVD can be given in pregnancy
What is true though after first trimester?