Hodgkinlymfoom

Inhoudsopgave

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<65-70: DHAP / VIM / DHAP / BEAM met curatieve intentie
- bij PR: 50% curatiekans
indien mogelijk RT
- ook monotherapie radiotherapie kan curatief zijn, met name bij vroeg stadium ziekte
CD30-positief: brentuximab
- na AuSCT of 2 eerdere therapieen
- indien niet fit genoeg voor AuSCT eerst chemotherapie
pembrolizumab
chemotherapie
- 3x DHAP / VIM
- ChlVVP

Serum albumin <4 g/dL
Hemoglobin <10.5 g/dL
Male gender
Age >45 years
Stage IV disease
White blood cell count ≥15,000/microL
Absolute lymphocyte count <600/microL and/or <8 percent of the total white blood cell count

Large mediastinal mass, size at least one third of the maximum thorax diameter
Extra-nodal disease
Involvement of three or more nodal areas
Elevated erythrocyte sedimentation rate
- > 50 mm/h for stages IA, IIA and
- > 30 mm/h for stages IB,IIB

Cottswold, zie plaatje en addendum

(a) Unexplained weight loss of more than 10% of the body weight during the 6 months before initial staging investigation
(b) Unexplained, persistent, or recurrent fever with temperatures above 38°C during the previous month
(c) Recurrent drenching night sweats during the previous months

largest dimension (cm) of the largest node or conglomerate node mass in each region of involvement 10 cm or greater: "bulky".
mediastinal mass: "bulky" on PA chest radiograph when maximum width is equal or greater than one-third of the internal transverse diameter of the thorax at the T5-T6 level maximal inspiration in the upright position at a source-skin distance of 2 m.

Involvement of extra Iymphatic tissue on one side of the diaphragm by limited direct extension from an adjacent nodal site will be classified as extranodal extension (E) with the implicit expectation of a prognosis equivalent to that for treatment of nodal disease of the same anatomical extent. The E category may also include an apparently discrete single extranodal deposit consistent with extension from a regionally involved node. Multiple extranodal deposits will not be included. A single extralymphatic site as the only site of disease should be classified as IE.

Nodal disease (I-III)

Stage I: single lymph node region (e.g. cervical, axillary, inguinal, mediastinal) or lymphoid structure as spleen, thymus and Waldeyer's ring.
Stage II: two or more lymph node regions or Iymph node structures on the same side of the diaphragm. Hilar nodes should be considered to be "lateralized" and when involved on both sides, constitute stage II disease. The number of anatomical regions involved should be indicated by a subscript (e.g. II3). For the purpose of defining the number of anatomical regions, all nodal disease within the mediastinum is considered to be a single Iymph node region. Hilar involvement constitutes an additional site of involvement.
Stage III: lymphoid structures on both sides of the diaphragm. This may be subdivided stage III1 or III2, stage III1 being described for patients with spleen or splenic, hilar, coeliac or portal node involvement and stage III2 for those with paraaortic, iliac or mesenteric node involvement.
Bulky disease: The subscript "X" will be used if bulky disease is present. No subscripts will be used in the absence of bulk.
Extranodal disease:"E" subscript if limited extranodal extension as described above, is documented. More extensive extranodal disease will be designated stage IV.
Example: Asymptomatic clinically staged patient with bilateral neck and axillary nodes, bulky mediastinum, enlarged left hilar node and extension into chest wall: CSII6XEA.

Ref:

Carbone PP, Kaplan HS, Musshoff K, et al. Report of the committee on Hodgkin's disease staging classification. Cancer. Res. 31:1860-1861, 1971.
Ref: Lister TA, Crowther D, Sutcliffe SB, et al. Staging for Hodgkin's disease. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin's disease: Cotswolds meeting. J. Clin. Oncol. 7:1630-1636, 1989 (Erratum J. Clin. Oncol. 8:1602, 1990).