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Frontline Paid New York, Ny a Lymphoma Rounds Publication Permit #370 Lymphoma Rounds Leadership Chicago - Loyola University Chicago New England - Baystate Medical MD, PhD; Francesca Montanari, Anna Niewiarowska, MD - Scott Smith, MD, PhD, FACP; Center - Armen Asik, MD; Beth MD; Hackensack University Medical Patrick Stiff, MD; Northwestern Israel Deaconess Medical Center Center - Andre Goy, MD, MS; Icahn Seattle - Kaiser Permanente University - Leo Gordon, MD, - Jon Arnason, MD; Robin Joyce, School of Medicine at Mount Sinai - Washington - Eric Chen, MD, PhD; FACP; Reem Karmali, MD, MS MD; Boston University School of Joshua Brody, MD; Memorial Sloan The Polyclinic - Sherry Hu, MD, (chair); Jane Winter, MD; Rush Medicine - J. Mark Sloan, MD; Kettering Cancer Center - Anthony PhD; Swedish Medical Center - University Medical Center - Jerome Brown University School of Medicine Mato, MD, MSCE; David Straus, Hank Kaplan, MD; John Pagel, Loew, MD; Sunita Nathan, MD; - Adam Olszewski, MD; Dana- MD (chair); NYU Langone Medical MD, PhD, DSc (chair); University of Parameswaran Venugopal, MD; Farber Cancer Institute - Jorge Center - Catherine Diefenbach, Washington - Paul S. Martin, MD; The University of Chicago - Sonali Castillo, MD; Ann LaCasce, MD, MD; Rutgers Cancer Institute of The University of Washington/Fred Smith, MD; Girish Venkataraman, MSc; Dartmouth-Hitchcock Medical New Jersey - Joseph Bertino, MD; Hutchinson Cancer Research Center MD; University of Illinois at Chicago Center - Elizabeth Bengtson, Andrew Evens, DO, MSc, FACP; - Stephen Smith, MD; Virginia - Frederick Behm, MD; David MD; Erick Lansigan, MD; Lahey Weill Cornell Medicine - Koen van Mason Medical Center - David Peace, MD Hospital and Medical Center - Tarun Besien, MD, PhD; Ethel Cesarman, Aboulafia, MD Kewalramani, MD; Massachusetts MD, PhD; Amy Chadburn, MD; Los Angeles - Cedars-Sinai Medical General Hospital Cancer Center- Morton Coleman, MD Washington, D.C. - Georgetown Center - Yuliya Linhares, MD; City Jeremy Abramson, MD, MSc University Hospital Lombardi of Hope - Auayporn Nademanee, (chair); Jeffrey Barnes, MD, PhD; Philadelphia - Cooper University Comprehensive Cancer Center MD; Harbor-UCLA Medical Center Tufts Cancer Center - Andreas Hospital - Andres Ferber, MD; - Bruce D. Cheson, MD, FACP, - Kathy Pan, MD; Olive View-UCLA Klein, MD; UMass Memorial Medical Hackensack University Medical FAAAS (chair); George Washington Medical Center - Jeffrey Miller, Center - Jan Cerny, MD, PhD, Center - Tatyana Feldman, MD; University Cancer Center - Kieron MD; University of California, FACP; Muthalagu Ramanathan, Rutgers Cancer Institute of New Dunleavy, MD; Mitchell Smith, Irvine - Elizabeth Brem, MD; MD; University of Vermont College Jersey - Andrew Evens, DO, MSc, MD, MS; Eduardo Sotomayor, Lauren Pinter-Brown, MD, FACP of Medicine - Julian Sprague, FACP; Thomas Jefferson University MD; MedStar Washington Hospital (chair); University of California, Los MD, PhD; Yale University School of -Ubaldo Martinez-Outschoorn, Center - Aarthi Shenoy, MD; Angeles - Herbert Eradat, MD, MS; Medicine - Francine Foss, MD MD; University of Pennsylvania - National Cancer Institute - Mark University of Southern California - Stefan Barta, MD, MS, MRCP (UK); Roschewski, MD; University of Ann Mohrbacher, MD New York - Columbia University Stephen Schuster, MD (chair); Virginia Cancer Center - Craig Medical Center - Owen O’Connor, Vita Medical Associates, PC - Portell, MD NONPROFIT ORGANIZATION US POSTAGE FRONTLINE PAID NEW YORK, NY A LYMPHOMA ROUNDS PUBLICATION PERMIT #370 Lymphoma Research Foundation Wall Street Plaza 88 Pine Street, Suite 2400 New York, NY 10005 RETURN SERVICE REQUESTED lymphoma.org Winter 2019 Issue 8 A LYMPHOMA ROUNDS PUBLICATION IN THIS ISSUE Hodgkin Lymphoma in 1 Hodgkin Lymphoma in Older Patients Anem Waheed, MD Tufts University School of Medicine Older Patients (Moderator) Andreas Klein, MD Tufts University School of Medicine Presenters 4 A Rash Case of Peripheral T-Cell Anem Waheed, MD, Tufts University School of Medicine Lymphoma Andreas Klein, MD, Tufts University School of Medicine Albert Yeh, MD Fred Hutchinson Cancer Research Center, At the New England Lymphoma Rounds on September 26, 2018, Anem Waheed, MD, of Tufts University of Washington University, discussed a case of Hodgkin lymphoma in an older patient. Andreas Klein, MD, (Pathology) Sony Kilgore, MD of Tufts University, was the moderator. Kaiser Permanente (Moderator) Nina Lamble, MD Seattle Cancer Care Alliance at Northwest Case Background Hospital and Medical Center, University of A 67-year-old male presented to a dermatologist with pruritus of the lower extremities. Washington Additional complaints included marble-sized lymphadenopathy of the right neck, night sweats, dyspnea on exertion, fatigue, and weight loss. Past medical history is significant 6 Management of an Aggressive B Cell for type 2 diabetes, hypertension, hyperlipidemia and a 45-year history of cigarette use. Lymphoma He is a retired metal worker. Physical examination, performed following referral to a Tracie Watson, DO, MS hematologist-oncologist, revealed excoriated regions of the skin of the lower extremities, Loyola University Chicago (Pathology) Aadil Ahmed, MD Continued on page 2 Loyola University Chicago (Moderator) Scott Smith, MD, PhD, FACP Loyola University Chicago lymphoma.org/FRONTLINE Frontline is a Lymphoma Research Foundation (LRF) publication that features selected case presentations from LRF’s Lymphoma Rounds professional education program, which provides a forum for local lymphoma healthcare professionals to meet on a regular basis to discuss actual lymphoma cases in a collaborative environment. Lymphoma Rounds is currently held in eight U.S. cities with participation of over 55 academic and community centers. For more information please visit: lymphoma.org/ProfessionalED Dr. Anem Waheed (left) and Dr. Andreas Klein (right) presented at the New England Lym- phoma Rounds meeting on September 26, 2018. lymphoma.org 1 Hodgkin Lymphoma in Older Patients Continued from page 1 1.5 to 2 cm right cervical An excisional biopsy of the mass in the right initial clinic visit, he was assessed to have an lymphadenopathy and 3 cm right hepatic lobe revealed effaced architecture international prognostic score (IPS-7) of 7 and supraclavicular lymphadenopathy; with nodular proliferation of large atypical an ECOG performance status of 2. neither axillary lymphadenopathy nor lymphoid forms. Reed-Sternberg cells hepatosplenomegaly were present. were noted. Immunohistochemical The patient was enrolled into a multicenter, Initial laboratory studies revealed WBC staining revealed CD30+, CD15+, CD45- open-label phase 2 study for older, previously of 19,900 with an absolute neutrophil status, consistent with classical Hodgkin untreated patients with Hodgkin lymphoma. count of 17.8 and an absolute lymphocyte lymphoma, nodular sclerosis subtype, He completed the study, receiving 2 cycles of count of 0.4, hemoglobin of 11.5 g/dL with stage 4 disease. brentuximab vedotin (BV) every 3 weeks, 6 an MCV of 75, platelet count of 557/µL, cycles of doxorubicin, vinblastine, dacarbazine elevated ESR and ferritin, serum albumin Case Evolution (AVD), followed by 4 additional cycles of BV of <4 g/dL and LDH of 307 U/L. An incidental finding on the CT scan of the every 3 weeks. Currently, the patient is 70 neck revealed severe left internal carotid years old and in clinical remission. Diagnosis artery stenosis, which was subsequently CT scan of the neck, chest, abdomen and confirmed by a carotid duplex ultrasound Discussion pelvis revealed: lymphadenopathy in the study which showed 80-99% stenosis of the Although the median age of diagnosis for right supraclavicular region measuring left internal carotid artery. One Hodgkin lymphoma is 39 years, up to 20% 7.5 X 4.2 x 5.8 cm; multiple enlarged week after the diagnosis of Hodgkin of patients are over 60 years of age at the lymph nodes in the mediastinum, axilla lymphoma, the patient underwent a left time of diagnosis. An older age at the time of and retroperitoneum; multiple ill-defined carotid endarterectomy and developed diagnosis correlates with decreased overall hepatic masses, including a right hepatic complications of a hematoma that required survival at 5 and 10 years, compared with lobe mass of 5 x 4.2 cm. PET scanning evacuation, and left leg weakness of patients diagnosed at younger ages. The revealed increased FDG-avidity in the unclear etiology. The patient presented etiology of the poorer outcomes for older regions of the enlarged lymph nodes. to Tufts Medical Center for outpatient patients is not completely understood, but Bone marrow aspiration and biopsy were evaluation in the oncology clinic from an contributing factors are believed to be the hyper-cellular for age (60% cellularity). inpatient rehabilitation facility. At his Continued on page 3 Free Materials For Your Patients - Order Today The Lymphoma Research Foundation (LRF) is here to support you and your patients. As healthcare professionals, you know the challenges patients face when diagnosed with cancer. LRF offers a wide range of lymphoma-focused educational materials for patients and their loved ones, free of charge. Please contact the LRF Helpline to request free publications and bulk orders for your office, at [email protected] or 800-500-9976. 2 lymphoma.org Hodgkin Lymphoma in Older Patients Continued from page 2 presence of significant comorbidities, poorer performance status, possible differences in disease biology (an increased incidence of mixed cellularity is noted in older patients
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