Hodgkin's%20lymphoma Management

Management

Follow Up

Tests After Completion of Initial Therapy

Restaging via PET-CT scan should be done after completion of chemotherapy, based on the Deauville criteria
- Favorable, unfavorable and aggressive classic Hodgkin lymphoma (CHL) restaging should be based on the Deauville criteria
- Restaging of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) patients is recommended after completion of initial therapy

PET 5-Point Scale (Deauville Criteria)

Score	PET-CT scan result
1	No uptake
2	Uptake ≤ mediastinum
3	Uptake > mediastinum but ≤ liver
4	Uptake moderately higher than the liver and visually above adjacent background activity
5	Uptake markedly higher than the liver and/or new lesions
X	New areas of uptake unlikely to be related to lymphoma

Biopsy and PET-CT scan may be requested for patients with Deauville 4-5 score after completion of therapy
CT scan with contrast of the neck, chest, abdomen, and pelvis may be requested at 6, 12 and 24 months after completion of therapy or as clinically indicated
Other imaging studies of initially involved sites (eg ultrasonography, chest radiography) may be repeated
The following should be tested annually 5 years after therapy completion:
- Blood pressure
- Complete blood count (CBC), platelets, chemistry profile
- Thyroid stimulating hormone (TSH) (for patients with radiotherapy to the neck)
- Lipid profile (2x/year)
- Fasting glucose
- Breast examination with mammography and magnetic resonance imaging (MRI) (8-10 years post-therapy or at age 40 years, whichever comes 1st) are advised for women previously irradiated at the chest or axillary area
- Colonoscopy every 10 years for patients >50 years old

Timing of Follow-up

Yearly follow-up should be advised for the 1st 5 years after treatment
Patients should undergo complete history taking and physical examination every 3-6 months for 1-2 years, then every 6-12 months until year 3 and then yearly
Thorough physical examination and psychologic evaluation is recommended every 4-6 month for the first 5 years
CBC, platelet count, erythrocyte sedimentation rate (ESR), and chemistry profile should be obtained as clinically indicated
Physical exams and blood tests (CBC, ESR, blood chemistry) should be done for NLPHL patients every 3-6 months for 1-2 years, then every 6-12 months for the next 3 years, then annually
A low-dose CT scan of chest may be requested after 5 years for patients at increased risk for lung cancer and have undergone treatment with non-alkylating chemotherapeutic agents, no previous radiation therapy, and no other risk factors

Management of MDROs in the ICU and the role of newer antimicrobial agents

Prof. David Paterson, 30 Mar 2021

Intensive care unit (ICU) patients are at risk of developing serious infections with multidrug-resistant organisms (MDROs), which require appropriate and adequate antibiotic coverage. Early empirical coverage is pivotal in saving patients’ lives. At a recent webinar co-organized by the Society of Infectious Disease (Singapore) and Pfizer, renowned Professor David Paterson, Professor of Medicine and Director, The University of Queensland Centre for Clinical Research, and Consultant Infectious Diseases Physician, Royal Brisbane and Women’s Hospital, Brisbane, Australia, discussed the role of newer antimicrobial agents, including ceftazidime-avibactam (Zavicefta) in the management of MDROs in the ICU. Dr Wong Sin Yew, Infectious Disease Physician at Gleneagles Medical Centre and Mount Elizabeth Novena Specialist Centre, Singapore, chaired the event.

Optimizing metastatic hormone-sensitive prostate cancer treatment in advanced prostate cancer

Assoc Prof. Darren Poon, Assoc Prof. Edmund Chiong, 14 Jan 2021

Metastatic hormone-sensitive prostate cancer (mHSPC) refers to the condition whereby patients have metastatic prostate cancer and no prior hormonal therapy or androgen deprivation therapy (ADT). Typically, patients with mHSPC have been treated with ADT alone, following which, the overwhelming majority develop castration resistance over time and head towards eventual mortality. In recent years, the publication of various landmark trials has prompted dramatic changes in the mHSPC treatment landscape, and had favourably impacted overall survival (OS) in these patients. At a recent webinar, A/Prof Darren Poon, Honorary Consultant in Clinical Oncology, Hong Kong Sanatorium & Hospital, and Honorary Clinical Associate Professor, Department of Clinical Oncology, The Chinese University of Hong Kong, reviewed treatment options in mHSPC, while A/Prof Edmund Chiong, Head and Senior Consultant, Department of Urology, National University Hospital, Singapore, presented a case which was discussed by an esteemed panel of experts. This webinar was jointly organized by the Singapore Society of Oncology and the Singapore Urological Association, and supported by Astellas.

SARS-CoV-2 Variants: Everything you need to know

01 Feb 2023

The COVID-19 pandemic continues to evolve with the emergence of new SARS-CoV-2 variants. The variants of concern have the potential to impact the transmissibility, virulence, and clinical presentation of the disease, affecting the epidemiology, public health measures, and diagnostic and therapeutic options. Mutations in the spike protein of the virus have increased its ability to infect humans and evade neutralization by natural or immunisation-induced antibodies. The highly mutated Omicron variant of SARS-CoV-2 has multiple sublineages with varying transmissibility and immune evasion potential. Pre-exposure prophylaxis plays a crucial role in protecting the immunocompromised populations against severe disease; however, the rapidly changing landscape of the variants poses a major challenge to the current and future effectiveness of pre-exposure prophylactic monoclonal antibodies.