Page 449 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

CHAPTER 22 ■ Lymphoid and Plasma Cell Neoplasms 433

FIGURE 22.14 Ree -Sternberg cell typic l o Ho gkin ise se.

(Reprinte ro Rubin E, F rber JL. Pathology, 3r e , Phil elphi ,

PA: Lippincott Willi s & Wilkins, 1999, with per ission.)

FIGURE 22.16 Cl ssic l Ho gkin ly pho . CD30-positive

v nces, neutrophili with tot l leukocyte counts o 15 Ree -Sternberg cells. (Cytoche ic l st in.) (Reprinte ro

to 25 × 10 /L evelops. Neutrophili , v rying egrees o Or zi A, Fouc r K, Knowles D, Weiss LM. Knowles Neoplastic
9
eosinophili , n onocytosis beco e pp rent on periph- Hematopathology, 3r e , Phil elphi , PA: Lippincott Willi s &

er l s e rs s the ise se progresses. In the l ter st ges o Wilkins, 2013, with per ission.)
the isor er, ost p tients evelop ly phocytopeni n

thro bocytopeni . IL-2 pro uction, n incre se sensitivity to suppressor
Multinucle te gi nt cells or l rge ononucle r cell onocytes n nor l -suppressor cells.

v ri nts (ly phocyte n histiocyte) re seen in Ho gkin T e cellul r origin o the Ree -Sternberg cell is unknown,
ise se. T ese cells ccount or bout 1% o the cells in but Ree -Sternberg cells h ve been shown to unction s

b ckgroun o in tory cells consisting o s ll ly - sti ul tory cells in ny ly phocyte re ctions, s ccessory
phocytes, histiocytes, neutrophils, eosinophils, n pl s cells in itogen-in uce -cell proli er tion, n s ntigen-

cells. presenting cells in HLA-DR–restricte , ntigen-specif c
Ho gkin ise se is ch r cterize by the presence o Ree - -cell ctiv tion.

Sternberg cells (Fig. 22.14) in the ly ph no es. T e no es n
other ly phoi tissue re o en inf ltr te with ly phocytes, Prognosis

reticulu cells, f brocytes, pl s cells, onocytes, n Ho gkin ly pho is high cur ble or o chil hoo c n-
eosinophils. Fibrosis n necrosis re requent f n ings. cer, with 5-ye r surviv l r tes excee ing 98%.

Ho gkin ise se (Figs. 22.15 n 22.16) is consi ere In the e rly st ges o Ho gkin ise se, exten e f el irr -
istinct clinic l entity. A i gnosis is e pri rily by i tion only w s previously the st n r ther py. Rel pse

ex in tion o histology sections o ly ph no es. occurre in pproxi tely one thir o p tients. o y, co -
Ho gkin ise se is ch r cterize by persistent e ect in bine o lity tre t ent with bbrevi te che other py

the cellul r i unity with bnor lities in ly phocytes, n li ite irr i tion h s re uce the rel pse r te, but
r i tion ther py incre ses the risks o secon c ncer.

Zev lin is the f rst n only r ioi unoconjug te (RIC)

to be pprove by the U.S. FDA or the tre t ent o CD20-

positive rel pse or re r ctory, low-gr e, ollicul r, or tr ns-

or e B-cell NHL, inclu ing rituxi b-re r ctory ollicul r

NHL. T e toxicity o this tre t ent is pri rily he tologic l.

Approxi tely 20% o p tients require tr ns usions o pl te-

lets n RBCs. Severe neutropeni , thro bocytopeni , n

ne i occur in up to 30% o tre te p tients. Docu ente

re issions r nge ro 3 to 5+ ye rs ollowing tre t ent.

T e tre t ent o v nce Ho gkin ise se w s i prove

consi er bly with the intro uction o co bin tion che o-

ther py—initi lly echloreth ine, vincristine, proc r-

b zine, n pre nisone (MOPP) n l ter the ABV or

o oxorubicin, bleo ycin, vinbl stine, n c rb zine
FIGURE 22.15 Ho gkin ly phocyte–rich “cl ssic” Ho gkin
ise se. T e b ckgroun is pri rily ly phocytes with Ree - (ABVD). P tients receiving these ther pies h ve 20% to

Sternberg cells. (Reprinte ro Greer JP, et l. Wintrobe’s Clinical 25% rel pse r te. Esc l te oses o f rst-line che other py

Hematology, 11th e , Phil elphi , PA: Lippincott Willi s & n consoli tion r i tion ther py h ve lowere the rel pse

Wilkins, 2004, with per ission.) r te but without i prove ent in surviv l.