NCCN Christchurch Hodgkin Lymphoma Great success story LMIC gt50 010yrs old Striking male predominance Symptoms 60 lt 6months B symptoms 40 Wt loss Fever Night sweats Staging ID: 1045178
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1. Hodgkin LymphomaRob CorbettNCCNChristchurch
2. Hodgkin LymphomaGreat success story!LMIC>50% 0-10yrs oldStriking male predominanceSymptoms60% < 6monthsB symptoms 40%Wt lossFeverNight sweatsStagingI – localised to single LN groupII- 2 or more groups on one side of diaphragmIII – disease on both sides of diaphragm incl liver/spleenIV – extranodal disease – BM, lung etc
3. Hodgkin Lymphoma70% stage I and II50% mixed cellularity subtypeOverall event-free survival 80%Stage I-II 90%Stage III-IV 60%
4. Hodgkin Lymphoma7 yo maleUnwell for 6 monthsFluctuating symptomsTirednessUnexplained feversNight sweatsLOWTraditional healers unhelpfulo/e:Looks reasonably wellThinLarge fleshy non-tender bilat cervical and supraclavicular LNsAbdomen normalNo evidence infectionCXR normal FBC – mild anaemiaCourse of Abs – no responseReferred to surgeons for excision biopsy
5. Hodgkin LymphomaBiopsy shows Hodgkin Lymphoma – mixed cellularity subtypeCT scan neck to pelvis – neck nodes and paratracheal lymph nodes? Bone marrow examinationIf FBC abnormalStages III and IVDiagnosis – stage IIB Mixed Cellularity Hodgkin Lymphoma
6. Hodgkin LymphomaTreatmentABVD Doxorubicin 25mg/m2 iv days 1 and 15Bleomycin 10mg/m2 iv days 1 and 15 (1mg=1000IU)Vinblastine 6 mg/m2 iv days 1 and 15 Dacarbazine 375mg/m2 iv days 1 and 15 7.4 Second cycle of ABVD starts on day 29. Subsequent cycles are at 28 day intervals until completion of 6 cyclesOutcomeTreatment relatively uncomplicatedWatch:Bone marrow suppressionNutritionVesicantsCompletes therapyNo evidence lymphoma recurrence after 3 yrs – cured!Late effectsSterilityCardiacPulmonary2nd cancers