Devita, Hellman, and Rosenberg's Cancer

LWBK1006-30 LWW-Govindan-Review December 12, 2011 19:35

434 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

primarily humoral Th2 response, which helps the growth of malignant

cells in cHL.

Answer 30.39. The answer is C.

Transformation of NLPHL to DLCBL occurs in 2% to 6% of cases.

The complete response rate after initial therapy is more than 90%. The

immunophenotype is an important part of the definition of

NLPHL. Unlike typical B-cell lymphomas, however, they are usually

immunoglobulin-negative by routine techniques.

Answer 30.40. The answer is D.

In the GHSG, the OS of LRCHL was significantly worse than that of

NLPHL.

Answer 30.41. The answer is C.

Rare cases of B-cell CLL may contain RS cells, and others may evolve

into HL (HL variant of Richter syndrome). These cases may or may not

be clonally related to the CLL. Lymphomas are presumed to arise in the

setting of immune deficiency (estimated risk 1% to 5%), and cases of MF,

lymphomatoid papulosis, and HL have been reported. Recent GEP data

suggest that mediastinal large B-cell lymphoma is closely related to cHL.

Answer 30.42. The answer is D.

Patients with nodular sclerosis (NS) and mixed cellularity (MC) most

convincingly display contiguous HL spread. The left and right sides of

the neck were each involved in greater than 60% of patients with NS

and MC histologies. These sites were at least four times more common

as other nodal sites above and below the diaphragm. Most patients with

NS or MC HL have a central pattern of nodal involvement (cervical,

mediastinal, para-aortic). In MC histology, the spleen is more frequently

involved, along with adenopathy below the diaphragm and B symptoms.

Answer 30.43. The answer is C.

Patients who relapse after RT alone for conventional HL have satisfactory

results with conventional combination chemotherapy. Prior RT does not

cause drug resistance or a clinically significant compromise of chemother-

apy dose intensity. Patients who relapse with stage IV disease or “B”

symptoms have a 10-year disease-free survival as high as 34% and should

be treated initially with conventional chemotherapy. It does appear that

ABVD gives a better disease-free survival when compared with MOPP in

patients with recurrence after radiation (81% with ABVD vs. 54% with

MOPP).

Answer 30.44. The answer is C.

Women also have a high risk of loss of fertility with pelvic irradiation.

There is a lower risk of loss of fertility in women aged less than 25 years

who are treated with chemotherapy, not RT.