Hodgkin’s disease

Hodgkin’s disease

Hodgkin’s Disease Part 1

What are some common salvage regimens for relapsed or refractory Hodgkin’s disease?

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PDL1 therapy
Brentuximab
autologous stem cell transplant
ICE
chlorambucil/vinblastine/ procarbazine/ prednisone
gemcitabine-based regimens

Hodgkin’s Disease Part 1
Hodgkin’s disease

What is a common residual mass seen in treated Hodgkin’s disease?

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Fibrosis

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Hodgkin’s disease

What is a false positive mediastinal mass that could be seen with PET scan in patients younger than 25
after treatment with ABVD?

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Thymus

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Hodgkin’s disease

What percentage of Hodgkin’s disease patients will have a residual mass on PET scan after therapy?

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80%

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Hodgkin’s disease

Which chemotherapy regimens should ideally not be used for Hodgkin’s disease first line?

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ABVD-COPP, BEACOPP, ABVD-MOPP, Stanford V

Hodgkin’s disease
Hodgkin’s disease

What 5-year freedom from progression rate is seen with ABVD with stage III and stage IV Hodgkin’s
disease?

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65%

Hodgkin’s disease
Hodgkin’s disease

Which criteria can help determine if only 2 cycles vs 4 cycles of chemotherapy and 2000 vs 4000 cGy of
radiotherapy can be utilized in stage I and 2 Hodgkin’s disease?

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mass is less than 10 cm in diameter, only 2 lymph node chains involved, normal ESR, no extranodal
sites

Hodgkin’s disease
Hodgkin’s disease

What is the standard treatment for stage I and stage II Hodgkin’s disease?

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4 cycles of chemotherapy and 3000 cGy of radiotherapy

Hodgkin’s disease
Hodgkin’s disease

When should PET/CT be used for Hodgkin’s disease?

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At diagnosis, monitoring during treatment, suspicious recurrence

Hodgkin’s disease
Hodgkin’s disease

What prognostic tool is superior to IPS prognostic score for Hodgkin’s disease?

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PET/CT after 2 cycles

Hodgkin’s disease
Hodgkin’s disease

Clinically, what 3 diagnostic tests / imaging modalities portend a poor outcome in Hodgkin’s disease?

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Bulky disease, elevated ESR, more than 2 sites involved

Hodgkin’s disease
Hodgkin’s disease

What 7 prognostic markers predict for poor outcomes in Hodgkin’s disease?

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Age greater than 45, male gender, stage IV disease, albumin less than 4, hemoglobin less than 10.5,
white blood cell count greater than 15, absolute lymphocyte count less than 800

Hodgkin’s disease
Hodgkin’s disease

What can replace a bone marrow biopsy at diagnosis for Hodgkin’s disease?

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PET/CT

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Hodgkin’s disease

What IHC markers distinguish Hodgkin’s disease from NLPHL?

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CD20

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Hodgkin’s disease

What Deauville score is considered a good response?

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1-3

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Hodgkin’s disease

Which patients may be considered for BEACOPP first line treatment ?

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Stage III and stage IV with 4 or more adverse features

Hodgkin’s disease
Hodgkin’s disease

What is the difference between the prognostic factors for stage I and 2 versus stage III and IV
forHodgkin’s lymphoma?

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Stage I and 2–age greater than 40, ESR greater than 50, at least 3 sites involved, mixed cellularity,
lymphocyte depleted, presence of constitutional symptoms, bulky disease
Stage III and 4–male gender, age greater than 45, albumin less than 4, hemoglobin less than 10.5, white
blood cell count greater than 15, absolute lymphocyte count less than 800

Hodgkin’s disease
Hodgkin’s disease

What defines an unfavorable risk group for stage I and stage II Hodgkin’s lymphoma ?

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Age greater than 40, ESR greater than 50, 3 or more disease sites, mixed cellularity, lymphocyte
depleted

Hodgkin’s disease
Hodgkin’s disease

What is the bare minimum IHC signature for Hodgkin’s disease?

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CD15 positive CD30 positive, CD20 negative

Hodgkin’s disease
Hodgkin’s disease

When can you consider leaving out radiotherapy in Hodgkin’s disease?

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No high-risk features including ESR, anemia, bulky disease, stage III and stage IV disease, complete
remission after only 2-3 cycles of chemotherapy

Hodgkin’s disease
Hodgkin’s disease

How can you manage stage IA NLPHL?

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Radiotherapy only

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Hodgkin’s disease

What is different about the treatment of NLPHL versus classic Hodgkin’s lymphoma?

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Rituximab addition

Hodgkin’s disease
Hodgkin’s disease

What is the treatment for NLPHL?

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Radiotherapy alone or ABVD x2 + radiotherapy

Hodgkin’s disease
Hodgkin’s disease

What cardiac disease will patients with Hodgkin’s disease develop from radiotherapy?

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Cardiomyopathy and coronary artery disease

Hodgkin’s disease
Hodgkin’s disease

What tests should women get after being treated for Hodgkin’s disease?

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Breast mammogram or MRI

Hodgkin’s disease
Hodgkin’s disease

With 2 cancers can result as a consequence of ABVD/XRT ?

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Diffuse large B-cell lymphoma, 5% at 10 years
Secondary solid cancer, 13% at 20 years

Hodgkin’s disease
Hodgkin’s disease

What are the major side effects of brentuximab?

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Neuropathy and pulmonary toxicity.

Hodgkin’s disease
Hodgkin’s disease

What is the recommended PET scan surveillance for Hodgkin’s disease when patients are in a complete
remission?

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Not recommended for surveillance

Hodgkin’s disease
Hodgkin’s disease

How can you to treat Hodgkin’s disease during pregnancy?

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ABVD during second trimester

Hodgkin’s disease
Hodgkin’s disease

What is the approach for unfavorable stage I and II disease Hodgkin’s lymphoma?

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4 cycles of systemic therapy and if good Deauville response 1-3 observation but if Deauville 4-5 then 2
more cycles of chemotherapy or involved field radiotherapy

Hodgkin’s disease
Hodgkin’s disease

What did the German HD10 clinical trial report for Hodgkin’s lymphoma?

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Stage I and 2 disease with no high risk features, treatment can be limited to chemotherapy with ABVD x
2 cycles and radiotherapy only 2000 cGy

Hodgkin’s disease
Hodgkin’s disease

What can lymphocyte rich and lymphocyte depleted Hodgkin’s disease be confused with?

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Lymphocyte rich – NLPHL
Lymphocyte poor – DLBCL

Hodgkin’s disease
Hodgkin’s disease

What Hodgkin’s disease subtype is associated with Epstein-Barr virus?

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Mixed cellularity

Hodgkin’s disease
Hodgkin’s Disease Part 2

What was the purpose of the AETHERA trial in r/r HD ?

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Brentuximab maintenance as consolidation following Autologous – HSCT for HD

Hodgkin’s Disease Part 2
Hodgkin’s Disease

Is there an improvement in ORR with the addition of nivolumab to brentuximab in r/r HD ?

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Yes, SGN35-016 reported an ORR of >80%, SGN35-025 trial

Hodgkin’s Disease
Hodgkin’s Disease

Is there an improvement in ORR with the addition of bendamustine to brentuximab in r/r HD ?

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Yes, SGN35-016 reported an ORR of >90%

Hodgkin’s Disease
Hodgkin’s Disease

Which regimen has shown superiority over other regimens in a phase 3 randomized trial in r/r HD ?

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None

Hodgkin’s Disease
Hodgkin’s Disease

What were the results of the ECHELON-1 trial ?

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A+AVD had superior combined risk of progression, death, or noncomplete response versus ABVD in advanced untreated Hodgkin’s disease

Hodgkin’s Disease
Hodgkin’s Disease

What did the ECHELON-1 trial determine ?

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A-AVD vs ABVD in stage III/IV untreated Hodgkin’s Disease

Hodgkin’s Disease
Hodgkin’s Disease

What is a major long-term (15y) AE associated with escalated dose BEACOPP ?

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Secondary malignancy, >7% reported in GHSG HD9 and HD12 trials

Hodgkin’s Disease
Hodgkin’s Disease

Has the Stanford V regimen shown superiority to ABVD in advanced untreated Hodgkin’s Disease ?

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No

Hodgkin’s Disease
Hodgkin’s Disease

What were the results of the GHSG HD11 trial for early unfavorable Hodgkin’s Disease ?

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BEACOPP does not improve outcomes over ABVD for early unfavorable Hodgkin’s Disease and if ABVD is chosen, it should be followed by 30Gy RT

Hodgkin’s Disease
Hodgkin’s Disease

What did the GHSG HD11 assess in early unfavorable Hodgkin’s Disease ?

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BEACOPP vs ABVD with either 20Gy or 30Gy RT

Hodgkin’s Disease
Hodgkin’s Disease

Is there randomized data to support the use of early PET adapted treatment for A+AVD in early stage unfavorable Hodgkin’s Disease ?

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No, only single-arm

Hodgkin’s Disease
Hodgkin’s Disease

What did the E2496 trial show for early stage unfavorable Hodgkin’s Disease ?

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Stanford V with RT was not superior to ABVD with RT for early stage unfavorable Hodgkin’s Disease

Hodgkin’s Disease
Hodgkin’s Disease

Is there randomized data to support the use of Stanford V for early stage favorable Hodgkin’s Disease ?

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No

Hodgkin’s Disease
Hodgkin’s Disease

What did the EORTC/LYSA/FIL H10 study reveal in early stage favorable Hodgkin’s Disease ?

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ABVD alone could not be shown to be non-inferior to ABVD + RT

Hodgkin’s Disease
Hodgkin’s Disease

What did the EORTC/LYSA/FIL H10 study try to assess in early stage favorable Hodgkin’s Disease ?

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Non-inferiority of ABVD alone for 2 cycles versus ABVD + RT with PET/CT after 2 cycles showed CR

Hodgkin’s Disease
Hodgkin’s Disease

What were the results of the UK NCRI RAPID in early favorable Hodgkin’s Disease ?

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ABVD x 3 without RT is inferior to ABVD x 3 with RT for 3-year PFS in NEG PET

Hodgkin’s Disease
Hodgkin’s Disease

What the purpose of the UK NCRI RAPID trial in early favorable Hodgkin’s Disease ?

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ABVD x 3 then PET then randomize to RT versus observation if NEG PET or 1 more cycle ABVD + RT if positive

Hodgkin’s Disease
Hodgkin’s Disease

Has radiotherapy alone been proven in a randomized fashion to be superior to chemo with or without radiation in early favorable Hodgkin’s lymphoma ?

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No

Hodgkin’s Disease
Hodgkin’s Disease

Is there phase 3 data to support the use of a truncated number of ABVD cycles in early stage favorable disease HL ?

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Yes

Hodgkin’s Disease
Hodgkin’s disease

What is unique about IHC staining patterns for Hodgkin’s disease versus NLPHL?

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NLPHL:
CD20, CD79a, CD45 -positive
CD15 and CD30-negative

Hodgkin’s disease
Hodgkin’s disease

What is seen on histology for NLPHL?

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Popcorn cells and L&H cells

Hodgkin’s disease
Hodgkin’s disease

Which sub-type of Hodgkin’s disease is considered an indolent B-cell lymphoma?

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NLPHL

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Hodgkin’s disease

Which Hodgkin’s disease sub-type is most commonly seen in young women?

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Nodular Sclerosing

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Hodgkin’s disease

Which Hodgkin’s disease sub-type is seen in developing countries ?

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Lymphocyte depleted

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Hodgkin’s disease

Which Hodgkin’s disease sub-type presents in elderly men with a mediastinal masses?

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Lymphocyte rich

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Hodgkin’s disease

Which 2 subtypes of Hodgkin’s disease are the most common?

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Nodular sclerosis and mixed cellularity

Hodgkin’s disease
Hodgkin’s disease

Which B-cell surface markers are negative in Hodgkin’s disease?

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CD20, CD79a, CD45

Hodgkin’s disease
Hodgkin’s disease

Which 2 cell surface markers are crucial for Hodgkin’s disease diagnosis?

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CD15 and CD30

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Hodgkin’s disease

Which sub-type of Hodgkin’s disease is not classical Hodgkin’s?

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Nodular lymphocyte predominant

Hodgkin’s disease
Hodgkin’s disease

What is a defining morphologic feature on histology of Hodgkin’s disease?

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Lymphoblasts surrounded by reactive inflammatory cells

Hodgkin’s disease
Hodgkin’s disease

Why do HIV patients have poor outcomes with Hodgkin’s disease?

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Extranodal disease more common

Hodgkin’s disease
Hodgkin’s disease

What are the known risk factors for Hodgkin’s disease?

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Mononucleosis, Epstein-Barr virus, HIV, bone marrow transplantation

Hodgkin’s disease
Hodgkin’s disease

What did the AETHERA clinical trial with Brentuximab show?

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Improved progression free survival when autologous stem cell transplant was consolidated with
Brentuximab

Hodgkin’s disease
Hodgkin’s disease

What is the standard of care following salvage systemic therapy for Hodgkin’s disease ?

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Autologous stem cell transplant

Hodgkin’s disease
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