1. Rob Corbett NCCN Christchurch
Hodgkin Lymphoma
Rob Corbett
NCCN
Christchurch

2. Hodgkin Lymphoma Great success story! LMIC Staging >50% 0-10yrs old
Striking male predominance
Symptoms
60% < 6months
B symptoms 40%
Wt loss
Fever
Night 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

3. Hodgkin Lymphoma 70% stage I and II 50% mixed cellularity subtype
Overall event-free survival 80%
Stage I-II 90%
Stage III-IV 60%

4. Hodgkin Lymphoma o/e: 7 yo male Unwell for 6 months CXR normal
Fluctuating symptoms
Tiredness
Unexplained fevers
Night sweats
LOW
Traditional 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 biopsy

5. Hodgkin Lymphoma
Biopsy shows Hodgkin Lymphoma – mixed cellularity subtype
CT scan neck to pelvis – neck nodes and paratracheal lymph nodes
? Bone marrow examination
If FBC abnormal
Stages III and IV
Diagnosis – stage IIB Mixed Cellularity Hodgkin Lymphoma

6. Hodgkin Lymphoma Treatment Outcome ABVD
Doxorubicin 25mg/m2 iv days 1 and 15
Bleomycin mg/m2 iv days 1 and 15 (1mg=1000IU)
Vinblastine mg/m 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 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
2nd cancers