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
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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


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


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


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


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


7/17


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


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


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


9/17



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)



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 :


10/17


#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,


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


12/17

$nclusion Criteria0

C" or #" F 8 months a%ter %irst line chemotherapy + - radiotherapy or second relapse

istologically pro&en relapse,


13/17

4edicinal 6ose 6ay

G-CS 5 Rgram *g 6 to neutrophil reco&ery

igh dose


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


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


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


17/17

#alliati&e treatment

hodgkin lymphoma klapper

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