Hodgkin's disease ´ëÀå°æ Á¤¸®
1. Reed-Sternberg cellÀÇ Ag expression: CD15, CD30
cf. CD15: lymphocyte predominant type¿¡¼´Â ¹ßÇöµÇÁö ¾Ê´Â´Ù.
CD30: ¸ðµç Reed-Sternberg cell¿¡¼ ¹ßÇöµÇ°í ¶ÇÇÑ ´Ù¸¥ ¸¹Àº ¼¼Æ÷¿¡¼µµ ¹ßÇöµÈ´Ù.
2. RS cellÀÇ origin: germinal centerÀÇ B cell
3. disease activity¸¦ Æò°¡Çϴµ¥ °¡Àå À¯¿ëÇÑ °Ë»ç: ESR
±× ¿Ü> Cu, Ca, ALP, lysozyme, globulins, CRP, other acute phase reactants
4. staging¿¡ ÇʼöÀûÀÎ Lab: CBC, LFT, RFT, uric acid, ESR
5. Stagin laparotomyÀÇ ´ë»ó: RT ´Üµ¶ÀÇ Ä¡·á´ë»óÀΠȯÀÚ¿¡¼ unsuspected abdominal
disease°¡ ÀÖÀ¸¸é Ä¡·á¹æÄ§ÀÌ ¹Ù²ð ¶§ ½ÃÇà
* ±Ý±â
i) bulky chest disease
ii) bulky abdominal involvement
iii) more than 4 nodal sites
iv) clinical stage III or IV
6. early stage¶óµµ combined modality treatment¸¦ ÇÏ´Â °æ¿ì = staging laparotomy°¡
Àǹ̾ø´Ù.
bulky mediastinal disease, significant B sx,
high-risk patient(mixed cellularity or lymphocyte-depletion histology, >40¼¼)
7. Hodgkin's diseaseÄ¡·á
I & IIA with good risk: RT alone without staging laparotomy
I & IIA with moderate risk: RT alone with staging laparotomy
combination CTx with RT
IIIA: combination therapy or ABVD alone
IIIB, IV: combination CTx alone ¡¾ RT
8. poor prognostic factors
1) early stage: male, multiple sites, ESR¡è, bulky mediastinal disease,
mixed cellularity or lymphocyte-depleted histology,
treatment with involved field RT
2) advanced stage : stage IV, B sx, inguinal node involvement, large mediastinal mass
male, bulky disease, anemia, leukocytosis, lymphocytosis
9. Ç×¾ÏÁ¦
1) ABVD: adriamycin/bleomycin/vinblastine/dacarbazine
ºÎÀÛ¿ë; cardiac toxicity, pulmonary fibrosis, myelosuppression(neutropenia)
2) MOPP : nitrogen mustard/oncovin/procarazine/prednisone
ºÎÀÛ¿ë: infertility, neuropathy, myelosuppression(thrombocytopenia)
secondary leukemia(MDS, acute leukemai, 5-10³âÈÄ)
10. °¡Àå ÈçÈ÷ µ¿¹ÝµÇ´Â paraneoplastic nephrotic syndrome? MCNS
12. HIV-associated Hodgkin's disease
NHLº¸´Ù ºóµµ°¡ ÈξÀ ÀûÀ¸³ª advanced stage, advanced course, extranodal involvement
°¡ ÈçÇϸç, Á¶Á÷µµ pleomorphic appearance¸¦ º¸¿© ÀÓ»ó¾ç»óÀÌ ³ª»Ú´Ù.
staging laparotomy´Â Àǹ̰¡ ¾ø´Ù.
routine PCP prophylaxis°¡ ÇÊ¿äÇϸç, CTxÁß¿¡ antiviral therapy°¡ ÇÊ¿äÇÏ´Ù.