Rob Corbett NCCN Christchurch Hodgkin Lymphoma Rob Corbett NCCN Christchurch

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

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

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

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

Hodgkin Lymphoma Treatment Outcome ABVD   Doxorubicin 25mg/m2 iv days 1 and 15 Bleomycin 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 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