Rob Corbett 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 ID: 548486
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Slide1
Hodgkin Lymphoma
Rob Corbett
NCCN
ChristchurchSlide2
Hodgkin Lymphoma
Great success story!
LMIC
>50% 0-10yrs oldStriking male predominanceSymptoms60% < 6monthsB symptoms 40%Wt lossFeverNight sweats
Staging
I – localised to single LN group
II- 2 or more groups on one side of diaphragm
III – disease on both sides of diaphragm
incl
liver/spleen
IV –
extranodal
disease – BM, lung
etc
Slide3
Hodgkin Lymphoma
70% stage I and II
5
0% mixed cellularity subtypeOverall event-free survival 80%Stage I-II 90%Stage III-IV 60%Slide4
Hodgkin Lymphoma
7
yo
maleUnwell for 6 monthsFluctuating symptomsTirednessUnexplained feversNight sweatsLOWTraditional healers unhelpful
o/e:
Looks reasonably well
Thin
Large fleshy non-tender
bilat
cervical and supraclavicular LNs
Abdomen normal
No evidence infection
CXR normal
FBC – mild anaemia
Course of Abs – no response
Referred to surgeons for excision biopsySlide5
Hodgkin Lymphoma
Biopsy shows Hodgkin Lymphoma – mixed cellularity subtype
CT scan neck to pelvis – neck nodes and
paratracheal lymph nodes? Bone marrow examinationIf FBC abnormalStages III and IVDiagnosis – stage IIB Mixed Cellularity Hodgkin LymphomaSlide6
Hodgkin Lymphoma
Treatment
ABVD
Doxorubicin 25mg/m2 iv days 1 and 15Bleomycin 10mg/m2 iv days 1 and 15 (1mg=1000IU)
Vinblastine 6 mg/m
2
iv days 1 and 15
Dacarbazine
375mg/m
2
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 cycles
Outcome
Treatment relatively uncomplicated
Watch:
Bone marrow suppression
Nutrition
Vesicants
Completes therapy
No evidence lymphoma recurrence after 3
yrs
– cured!
Late effects
Sterility
Cardiac
Pulmonary
2
nd
cancers