Download - Hodgkin Lymphoma Klapper
-
7/24/2019 Hodgkin Lymphoma Klapper
1/17
Hodgkin lymphoma
Reviewed: 15-05-07
Research
Histological classification
Stage Classification according to !nn !r"or Cotswolds recommendation#
Some definitions
Breakdown of all stages in A and B (to be specified as a suffix):
Prognostic score for advanced Hodgkin lympoma (! point eac item)
Schema $herapy %verview Hodgkin lymphoma
$herapy
%verall
Specific
Hodgkin lympoma" clinical stage # and ##
Hodgkin lympoma" clinical stage ### and #$ (#PS %&')
Hodgkin lympoma" clinical stage ### and #$ (#PS )
Primary refractory or early relapse (* monts)
Hodgkin lympoma" relapse+ monts to years after first conventional
polycemoterapy
Hodgkin lympoma" relapse+ years after first conventional polycemoterapy
Second or subse,uent relapse
&'idelines for patients who fall o'tside the (%R$C trials
Remaining chemotherapy regimens for the treatment of Hodgkin lymphoma
Related pages
)inks in this page
Research
Complete blood count, reticulocytes, BSE
Blood Chemistry -GT + + albumin
Biopsy (cytology possibly) other suspect localiations
Beenmerghistologie, cytology
C!", chest and abdomen CT scan (#ET scanning)
$% necessary, li&er biopsy (possibly under laparoscopic control)
$% desired %ertility research and sperm %reeing
http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e16http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e16http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e42http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e151http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e180http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e180http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e201http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e201http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e208http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e233http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e233http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e281http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e283http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e292http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e292http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e294http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e617http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e621http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e980http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1163http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1163http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1341http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1341http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1347http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1351http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1351http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1392http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#verwante_paginashttp://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#verwante_paginashttp://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#links_in_dezehttp://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e16http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e42http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e151http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e180http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e201http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e208http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e233http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e281http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e283http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e292http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e294http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e617http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e621http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e980http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1163http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1163http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1341http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1347http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1351http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#d0e1392http://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#verwante_paginashttp://translate.googleusercontent.com/translate_c?hl=id&ie=UTF-8&sl=nl&tl=en&u=http://www.hematologieklapper.nl/content/a5-05.htm&prev=_t&rurl=translate.google.co.id&usg=ALkJrhgwLx4VZoDkhiEv53kvW-Vlk-VzDQ#links_in_deze -
7/24/2019 Hodgkin Lymphoma Klapper
2/17
"e&ision biopsies by pathologist and by imaging radiologist (i% patient %rom another hospital)
' diagnosis can only classi%y a lymph nodebiopsy obtained
or research lin*ed to speci%ic (E"TC ./) studies0 see spot Each odg*in localiation is as accurate as
possible in sie and number to be recorded (gland sie, diameter lung spleen li&er spots, etc) and be registered
in a dra1ing
Histological classification
*H% +eat'res Comments
2ymphocytes Empire,
ductile (nodular
paragranuloom)
C345 -,C367 +,C387 -,
C395 +,C3:;a + -,E
-
7/24/2019 Hodgkin Lymphoma Klapper
3/17
$0 4 gland disorder or
$E0 4 e=tralym%atisch Bounded disorder o% body or territory
$$0 6 or more lym%*lierstations disorder (possibly as to indicate $$6 or $$8 etc) on the same side o% the diaphragm
or
$$E0 lym%*lierstations o% 6 or more and a limited condition o% a body or e=tralym%atisch %ield the same side o% the
diaphragm
$$$0 lym%*lierstations disorder on both sides o% the diaphragm, possibly accompanied by0
$$$E0 a condition o% a limited body o% e=tralym%atisch
$$$S0 disease o% the spleen or
$$$ES0 both
$.0 3i%%use disseminated disease o% 4 or more additional lymphatic organs or regions (to be speci%ied by a
symbol) 1ith or 1ithout disease o% lymph nodes
Some definitions
Positive spleen in Hodgkin:clinically ob&ious splenomegaly, or Duestionable splenomegaly 1ith the
ultrasound scan or multiple %ocal de%ects that are not based on cysts or &ascular abnormalities 'n
enlarged spleen on ultrasound alone is insu%%icient %or the diagnosis positi&e spleen
Advese live:multiple %ocal de%ects that are not based on cysts or &ascular abnormalities, recorded using
at least 6 imaging techniDues epatomegaly or li&er dys%unction alone are not su%%icient %or the
diagnosis o% li&er in&ol&ement $n this case li&er biopsy done
!one damage:pain or increased al* phosphatase, con%irmed by radiographs or isotope CT
-
7/24/2019 Hodgkin Lymphoma Klapper
4/17
B ne=plained 1eight loss (H 47> o% body 1eight) 1ithin I months and or une=plained %e&erH 8J K C %or
more than one 1ee*s and or pro%use night s1eats
.rognostic score for advanced Hodgkin lymphoma 1 point each item#
Serum albumin L97 g l
b LI5 mmol l
-
7/24/2019 Hodgkin Lymphoma Klapper
5/17
6 ndand subseDuent relapse $n remission, %ollo1ed by non-myeloablati&e allo-SCT
The nodular %orm o% lymphocyte rich (2#) subgroup is another disease (nodular paragranuloom) and is typically not
treated as odg*in?s disease %ten characteristic presentation 1ith solitary localiation, recurrences (#' reDuired)
a%ter long inter&als, inter-current or in history strong recurrent %ollicular hyperplasia
-
7/24/2019 Hodgkin Lymphoma Klapper
6/17
/o other malignancy
per%ormance grade 7 to 6
a&orable ()
Stage $ or $$ 1ith up to 8 in&ol&ed areas, and age L57 years and BSE L57 mm (1ithout B symptoms) or BSE L87
mm (1ith B symptoms) and dose led to modi%ication o% blood picture during the treatment (45 days)
)e'koencephalopathy 10 32 l gran 10 32 l $R%4, 10 32 l ! , 6
H 67 H 47 H :5 477 477 477 477
-
7/24/2019 Hodgkin Lymphoma Klapper
7/17
)e'koencephalopathy 10 32 l gran 10 32 l $R%4, 10 32 l ! , 6
L67 L47 L:5 57 477 57 57
477> dose modi%ication guided blood count at start o% the %ollo1ing treatment0 BCH 65, granulocytesH 45 and
plateletsH 465 $% not possible the %ull dose, 4 1ee* delay, then0
)e'koencephalopathy 10 32 l gran 10 32 l $R%4, 10 32 l ! , 6
H 67 H 47 H :5 477 477 477 477
L67 L47 L:5 57 477 57 57
Escalated BE'C## (6 courses)
dr'g dose 2 day ro'te days
Bleomycin 47 mg m 6 i& J
Etoposide 677 mg m 6 i& 48
'driamycin 85 mg m 6 i& 4
Cyclophosphamide 4657 mg m 6 i& 4
Cy dose o% 8 = i& Cy during, a%ter 9 and J hours a%ter
.incristine 6 mg i& 4
#rocarbaine 477 mg m 6 po 4:
#rednisone 97 mg m 6 po 4-49
G-CS 5 g *g sc %rom ; days to neutrophil reco&ery
-
7/24/2019 Hodgkin Lymphoma Klapper
8/17
Hodgkin lymphoma clinical stage and .S 0-#
IJ cycles 'B.3
Hodgkin lymphoma clinical stage and .S 8 9#
E"TC 67,7460
BE'C## (9 cycles escalated + 9 baseline cycles) &s 'B.3 (J cycles) in stage $$$ Q $. odg*in?s lymphoma)
$nclusion Criteria0
ntreated
-
7/24/2019 Hodgkin Lymphoma Klapper
9/17
dr'g dose 2 day ro'te days
Bleomycin 47 mg m 6 i& J
Etoposide 677 mg m 6 i& 48
'driamycin 85 mg m 6 i& 4
Cyclophosphamide 4657 mg m 6 i& 4
Cy dose o% 8 = i& Cy during, a%ter 9 and J hours a%ter
.incristine 6 mg i& 4
#rocarbaine 477 mg m 6 po 4 to :
#rednisone 97 mg m 6 po 4 to 49
G-CS 5 Rgram *g sc %rom ; days to neutrophil reco&ery
?Baseline? dose (9 courses, 4 = 8 1ee*s)
dr'g dose 2 day ro'te days
Bleomycin 47 mg m 6 i& J
Etoposide 477 mg m 6 i& 4 to 8
'driamycin 65 mg m
6
i& 4
Cyclophosphamide I57 mg m 6 i& 4
.incristine 6 mg i& J
#rocarbaine 477 mg m 6 po 4 to :
-
7/24/2019 Hodgkin Lymphoma Klapper
10/17
dr'g dose 2 day ro'te days
#rednisone 97 mg m 6 po 4 to 49
477> dose modi%ication guided blood count at start o% the %ollo1ing treatment0 BCH 65, granulocytesH 45 and
plateletsH 465
$% not the %ull dose possible, only 4 1ee* delay, then0
)e'koencephalopathy 10 3
2 l
&ran 10 3
2 l
$hrom"oem"olic 10 3
2 l Cyclo !dria cr ,leo (top .roc .R6
H 67 H 47 H :5 477 477 477 477 477 477 477
L67 L47 L:5 57 57 477 477 57 57 477
.rimary refractory or early relapse ;9 months#
3'#-.$ /aCl and /aC 849> 1hich added ACl,
-
7/24/2019 Hodgkin Lymphoma Klapper
11/17
4
6ose 6ay 6'ration of inf'sion
Etoposide ;7 mg m 6 4, 8, 5 6 hours
$%os%amide 4677 mg m 6 4 to 5 4 hours
-
7/24/2019 Hodgkin Lymphoma Klapper
12/17
$nclusion Criteria0
C" or #" F 8 months a%ter %irst line chemotherapy + - radiotherapy or second relapse
istologically pro&en relapse,
-
7/24/2019 Hodgkin Lymphoma Klapper
13/17
4edicinal 6ose 6ay
G-CS 5 Rgram *g 6 to neutrophil reco&ery
igh dose
-
7/24/2019 Hodgkin Lymphoma Klapper
14/17
ith radiotherapy and or chemotherapy in C", %ollo1ed by allogeneic (non-) myeloablati&e SCT
&'idelines for patients who fall o'tside the (%R$C trials
CS $ - $$ abo&e the diaphragm
$% %a&orable prognostic %actors (47-trial)0 8 = 'B.3 %ollo1ed by in&ol&ed node radiotherapy (87 Gy)
$% ad&erse prognostic %actors0 9 = 'B.3 %ollo1ed by in&ol&ed node radiotherapy (87 Gy)
CS $ - $$ under the diaphragm
This is rare
9 = 'B.3 %ollo1ed by in&ol&ed node radiotherapy is a good choice
CS $$$ - $.
'B.3 treatment (I-J), possibly %ollo1ed by iceberg radiotherapy (69-87 Gy)
ith aggressi&e recurrence can allogeneic non-myeloablati&e SCT considered
-
7/24/2019 Hodgkin Lymphoma Klapper
15/17
(,.: +re='ency: 1 2 9 weeks
.inblastine I mg m 6 i& 4 days
#rednisone 97 mg m 6 po days 4 to 5
477> dose modi%ication guided blood picture
*,C 10 32 l .latelets 10 32 l ( , .
H 65 H 465 477 477 477 477
45-65 :5-465 57 477 57 477
L45 @ L:5 @ 7 @ 7 @ 7 @ 7 @
@A$te / +eek delay optimal dosing sched#le as speci$ied in
4%.. 2 !, hy"rid c're rate 1 2 @ weeks
Chloormethine I mg m 6 i& 4 days
.incristine 6 mg i& 4 days
#rocarbaine 477 mg m 6 po days 4 to :
#rednisone 97 mg m 6 po days 4 to 49
3o=orubicin 85 mg m 6 i& J days
Bleomycin 47 mg m 6 $. or $< J days
.inblastine I mg m 6 i& J days
-
7/24/2019 Hodgkin Lymphoma Klapper
16/17
dose guided by the blood picture (not applicable to bone marro1 pancytopenia tg&
location)
)e'koencephalopathy 10 32 l or throm"oem"olism 10 32 l 4 % . . ! ,
H 65 H 465 477 477 477 477 477 477 477
45-65 :5-465 57 477 57 477 57 477 57
L45 L:5 7 7 7 7 7 7 7
or mild neuropathy0 &incristine hal% $n se&ere neuropathy0 &incristine stop and possibly replaced by &inblastine I
mg m 6
4%.. c're: +re='ency: 1 2 @ weeks
-
7/24/2019 Hodgkin Lymphoma Klapper
17/17
#alliati&e treatment