LWBK1006-30 LWW-Govindan-Review December 12, 2011 19:35
Chapter 30•Lymphomas 435Answer 30.45. The answer is B.
HL is the fourth most common cancer diagnosed during pregnancy and
has been reported in 1 of every 1000 to 6000 deliveries. Several studies
have shown that pregnancy does not worsen the clinical course of HL,
and that the long-term survival of pregnant women with HL is not differ-
ent from that of nonpregnant women. The ABVD regimen may be used
when chemotherapy is indicated beyond the first trimester. Because drugs
accumulate in the milk, mothers are advised not to breastfeed during
treatment.Answer 30.46. The answer is A.
More cases of secondary AML are seen after MOPP chemotherapy
because of exposure to alkylating agents. DLBCL is more often seen after
HL treatment.Answer 30.47. The answer is B.
RT, bleomycin, and high-dose BCNU exposure are all associated with a
higher risk of late complications, including severe pulmonary fibrosis.Answer 30.48. The answer is B.
The total rate of secondary neoplasms was highest in the COPP/ABVD
arm.Answer 30.49. The answer is D.
In the GHSG HD7 trial, the patients who received two cycles of ABVD had
a statistically significant improvement in freedom from treatment failure
(91% vs. 75% for irradiation alone,p<.0001). This study raised several
questions. Is the benefit in freedom from treatment failure worth the risk
of long-term toxicity from the exposure to doxorubicin and bleomycin?
Will it be more difficult to salvage the patients who relapse after the
irradiation if they have already received two cycles of ABVD? Only longer
follow-up will answer these questions.Answer 30.50. The answer is B.
The CD20 antigen is expressed on all malignant cells in nodular LPHL.
Two phase II trials with rituximab showed promising results with high
overall response rates (86% to 100%).Answer 30.51. The answer is C.
CD30 is expressed both in ALK-positive and ALK-negative anaplastic
large cell lymphomas, embryonal and nonembryonal carcinoma, leiomy-
sarcomas, rhabdomyosarcoma, aggressive fibromatosis, and malig-
nant fibrous histiocytoma (Durkop H et al. Journal of Pathology
2000;190:613–618), peripheral T cell lymphomas (PTCL-NOS) (Weisen-
burger DD et al. Blood 2011;117:3402–3408), and on mast cells in
systemic mastocytosis (Valent P et al. Leukemia lymphoma 2011;52:740–
744).