Hodgkin Lymphoma - Child Cancer Network

Hodgkin Lymphoma - Child Cancer Network

Hodgkin Lymphoma Rob Corbett NCCN Christchurch Hodgkin Lymphoma Great success story! LMIC >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 Fluctuating symptoms Tiredness Unexplained fevers Looks reasonably well Thin

Large fleshy non-tender bilat cervical and supraclavicular LNs Abdomen normal No evidence infection Night sweats CXR normal LOW FBC mild anaemia Traditional healers unhelpful 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 Treatment relatively uncomplicated ABVD Watch: Doxorubicin and 15 25mg/m2

iv days 1 Nutrition Bleomycin 10mg/m2 and 15 (1mg=1000IU) iv days 1 Vinblastine and 15 iv days 1 Dacarbazine and 15 Bone marrow suppression 6 mg/m 2

375mg/m2 iv days 1 Vesicants Completes therapy No evidence lymphoma recurrence after 3 yrs cured! Late effects Sterility 7.4 Second cycle of ABVD starts on day 29. Subsequent cycles are at 28 day intervals until completion of 6 cycles Cardiac Pulmonary 2nd cancers

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