Hodgkin's disease 대장경 정리

1. Reed-Sternberg cell의 Ag expression: CD15, CD30

cf. CD15: lymphocyte predominant type에서는 발현되지 않는다.

CD30: 모든 Reed-Sternberg cell에서 발현되고 또한 다른 많은 세포에서도 발현된다.

2. RS cell의 origin: germinal center의 B cell

3. disease activity를 평가하는데 가장 유용한 검사: ESR

그 외> Cu, Ca, ALP, lysozyme, globulins, CRP, other acute phase reactants

4. staging에 필수적인 Lab: CBC, LFT, RFT, uric acid, ESR

5. Stagin laparotomy의 대상: RT 단독의 치료대상인 환자에서 unsuspected abdominal

disease가 있으면 치료방침이 바뀔 때 시행

* 금기

i) bulky chest disease

ii) bulky abdominal involvement

iii) more than 4 nodal sites

iv) clinical stage III or IV

6. early stage라도 combined modality treatment를 하는 경우 = staging laparotomy가

의미없다.

bulky mediastinal disease, significant B sx,

high-risk patient(mixed cellularity or lymphocyte-depletion histology, >40세)

7. Hodgkin's disease치료

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 ± RT

8. poor prognostic factors

1) early stage: male, multiple sites, ESR↑, 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. 항암제

1) ABVD: adriamycin/bleomycin/vinblastine/dacarbazine

부작용; cardiac toxicity, pulmonary fibrosis, myelosuppression(neutropenia)

2) MOPP : nitrogen mustard/oncovin/procarazine/prednisone

부작용: infertility, neuropathy, myelosuppression(thrombocytopenia)

secondary leukemia(MDS, acute leukemai, 5-10년후)

10. 가장 흔히 동반되는 paraneoplastic nephrotic syndrome? MCNS

12. HIV-associated Hodgkin's disease

NHL보다 빈도가 훨씬 적으나 advanced stage, advanced course, extranodal involvement

가 흔하며, 조직도 pleomorphic appearance를 보여 임상양상이 나쁘다.

staging laparotomy는 의미가 없다.

routine PCP prophylaxis가 필요하며, CTx중에 antiviral therapy가 필요하다.