CHL and B symptoms

 Q: Which of the following is NOT considered a part of B symptoms in Classic Hodgkins Lymphoma (CHL)? - select one

A) Fever 

 B) Sweats 

 C) Weight loss 

 D) Pruritus 

 Answer: D 

It should be understood that B symptoms have a formal definition in Lugano classification. It has three components with its own defined delineations. 

1. Fever should be persistent and above  38°C (>100.4°F). There is a variation of fever known as Pel-Ebstein fever that may be present. This variation of fever cyclically increases and decreases over a period of one to two weeks. In most cases, the patient complains of subjective fever more in the evening time.

2. Sweats should be described by the patient as drenching night sweats 

3. Weight loss should not be explained by any other means and should be more than 10 percent of actual body weight over the past six months.

Pruritus (choice D) though is not considered as a B symptom but has a high diagnostic value. In some patients, it precedes by many months before an actual diagnosis is made. It is usually generalized and can be severe enough to cause intense scratching and excoriations. 

#oncology

References:

1. Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014; 32:3059.

2. Good GR, DiNubile MJ. Images in clinical medicine. Cyclic fever in Hodgkin's disease (Pel-Ebstein fever). N Engl J Med 1995; 332:436. 

3. Gobbi PG, Cavalli C, Gendarini A, et al. Reevaluation of prognostic significance of symptoms in Hodgkin's disease. Cancer 1985; 56:2874