Hematology
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| Hodgkin Disease includes (types): | Nodular Sclerosing (80%); LPHD; Classical Hodgkin Dz; Mixed cellularity
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| Non-Hodgkin Disease includes (types): | Follicular; Burkitt; Diffuse lg B-cell; Marginal zone; Cutaneous T-cell; Anaplastic large cell
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| Group of cancers w/enlarged lymphoid tissue, spleen, liver, & Reed-Sternberg cells | Hodgkin Dz
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| Hodgkin Disease prevalence | 7,900 cases/year. Bimodal: 20-40 then after 50; rare in kids <5; more common in men 15-45
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| Virus found in 40–50% of Hodgkin disease cases | EBV
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| Hodgkin Dz mechanism of spread in pt | Usually arises in a single area and spreads to contiguous nodes (“next-door disease”)
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| Hodgkin Dz S/S | Painless cervical , supraclavicular, & mediastinal LAD (pain w/drinking alcohol); constitutional B symptoms; SOB common with mediastinal mass.
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| Hodgkin Dz findings | Nodular sclerosis (esp young pt); Mixed cellularity (esp in older pts); prob infxs etiology in young pts (mononuc, x3 risk); 5-10% = extranodal presentation (lung, liver, bone marrow); Chest Xray: often mediastinal mass
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| Hodgkin Dz diagnostics | CXR, CT chest, abdomen, pelvis; PET scan; LN & bilateral BM bx. HIV test.
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| Hodgkin Dz Stage I: | one lymph node region
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| Hodgkin Dz Stage II: | two lymph node areas on same side of the diaphragm
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| Hodgkin Dz Stage III: | nodal disease, both above and below the diaphragm. Also may be extralymphatic (IIIE) or involving spleen (IIIS) or both (IIISE)
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| Hodgkin Dz Stage IV: | Extranodal disease. A: no sxs. B: sxs. C: bulky disease (eg, mediastinal widening)
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| Hodgkin Dz mgmt: Stage I and IIa: | Radiation alone
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| Hodgkin Dz mgmt: Stage IIb: | Controversial, radiation +/- chemotherapy
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| Hodgkin Dz mgmt: Stage III: | Chemo +/-radiation (ABVD)
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| Hodgkin Dz mgmt: Stage IV: | Chemotherapy
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| Hodgkin Dz: Five year survival rate: | > 80% (Will usually recur in 2 years if at all)
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| Hodgkin Dz: if relapse: | Consider high dose chemo followed by BMT
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| Hodgkin Dz mgmt | Chemo: ABVD; give chemo Q2 weeks x 4-6 cycles. Re-scan after 2-3 cycles to determine response. IFRT follows chemo. Watch for toxicity/neutropenia (use CSFs)
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| 5th most common malignancy in US | NHL
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| NHL prevalence | 60,000 new cases annually; median age 50 yrs; incidence higher in pts w/immunodeficiencies, h/o EBV, exposures to pesticides/solvents
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| Disease arising from cells in lymphoid tissue (90% of cases are derived from B-lympocytes) | NHL
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| 3 Grades of NHL | Indolent (low grade, slow growing); Intermediate (aggressive, mix of small to large cells); High Grade (very aggressive)
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| NHL S/S | Persistent, painless, isolated or diffuse LAD (retroperitoneum, mesentery, pelvis, extranodal: skin, GI tract); B symptoms (intermediate and high-grade dz); abd pain, N/V, bleeding, edema
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| NHL findings | Normal CBC but poss anemia, thrombocytopenia, & leukopenia; occ lymphoma cells on diff; bulky lymphadenopathy (poss cause jaundice, hydronephrosis, SVC syndrome, bowel obstruction, wasting)
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| NHL staging | CT chest, abdomen, pelvis; PET scan??; Unilateral or bilateral BM bx; LDH (tumor marker); LP if CNS dz is suspected
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| tumor lysis prophylaxis | Allopurinol, 300 mg/day, hydration, diuretics. May be indicated in NHL
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| Role of surgery in NHL | Diagnostic
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| Mgmt of Low Grade NHL | Dynamic observation (watch & wait) average of 6 yrs after dx. Rituximab weekly x4 weeks or R-CHOP or CHOP
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| Mgmt of Intermediate Grade NHL | R-CHOP or R-ICE or Bexxar (radiolabeled I-131) or Zevalin (radioimmunotherapy). ?BMT or SCT in relapse
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| Mgmt of High Grade Lymphoma (large B-cell lymphoma) | R-CHOP or R-ICE. Many lymphomas treated w/specific therapies (Burkitt lymphoma, post transplant lymphoproliferative disorder)
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| Lymphoblastic lymphomas are treated with: | Regimens similar for T-cell ALL
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| Bulky lymphadenopathy seen in: | CLL; NHL
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| Pel-Ebstein fever pattern is seen in: | Hodgkin disease (alternating periods of febrile and afebrile for days-weeks)
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| Hodgkin disease complications | Spinal cord compression. Late-treatment cardio & pulmo dz. 2nd malignancy. Hypothyroid & infertility after radation. Lower immunity.
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| Ann Arbor system is used to classify stages of: | Hodgkin disease and NHL
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| Working Formulation and REAL classification system are used to classify diagnoses of: | NHL (low, intermediate, and high-grade)
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| Constitutional B symptoms | fever, drenching night sweats, wt loss
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| Rituximab (monoclonal Ab) targets: | B-cells SAg CD20 cells
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| R-CHOP = | rituximab plus cytoxan, adriamycin, vincristine, prednisone
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