Hodgkin's Lymphoma Overview



Hodgkin's lymphoma (HL) is an uncommon hematological malignancy arising from mature B cells. It is characterized by the presence of Hodgkin's cells and Reed-Sternberg cells.



Hodgkin Lymphoma Epidemiology:

 • Lymphoma is divided into Hodgkin's and Non-Hodgkin's

 • Hodgkin's lymphoma accounts for 10% of all lymphomas

 • Annual incidence of about three cases per 100,000 persons

 • It has a bimodal age distribution curve - most adolescent



Hodgkin Lymphoma Risk Factors:

 • History of EBV infection

 • Family history

 • Young adults from higher socio-economic status

 • Immunosuppression

 • Autoimmune disorders



Hodgkin Lymphoma - Clinical Presentation:

 • Lymphadenopathy - painless, firm cervical or supraclavicular node

 • Anterior mediastinal mass/adenopathy

 • Cough

 • Dyspnea

 • Fever

 • Night sweats

 • Weight loss

 • Anemia

 • Pruritis

 • Erythema nodosum

 • Immune hemolytic anemia

 • Pain in LN on alcohol ingestion

 • B symptoms in 1/3 of patients



Classical Hodgkin Lymphoma (90-95% of cases) Classification:

 • The tumor cells in this group are derived from germinal center B cells, but typically fail to express many of the genes and gene products that define normal germinal center B cells. 

 • Classical HL is further divided into the following subtypes:

	- Nodular sclerosis classical HL (NSHL) - (most common)

	- Mixed cellularity classical HL (MCHL)

	- Lymphocyte rich classical HL (LRHL)

	- Lymphocyte depleted classical HL (LDHL)

	- Nodular lymphocyte predominant HL - The tumor cells in this subtype retain the immunophenotypic features of germinal center B cells



Hodgkin Lymphoma Workup:

 • Full Blood Count

	- Low Hb and platelets

	- WBC may be high or low

 • ESR (Inflammatory marker elevated)

 • Increased Serum Ferritin

 • Increased Serum Copper

 • Chest X-ray (Mediastinal mass)

 • CT scan - to check for other organ involvement

 • PET scan - activity

 • Excisional lymph node biopsy (diagnostic for HL and its variants)

	- LN biopsy shows Reed-Sternberg cells and inflammatory infiltrate

 • Immunohistochemical studies (to differentiate HL from other lymphomas, classical HL is characteristically CD30 positive and usually CD15 positive)

 • Staging laparotomies aren’t done anymore

 • Routine bone marrow biopsy - if blood abnormalities are present



Hodgkin Lymphoma Staging:

 • Based on number of sites of disease and presence of extranodal involvement

 • Staging through Ann Arbor criteria

 • Involves physical exam, CT scans and can also involve PET scans



Hodgkin Lymphoma Treatment

 • Early Stage (Favorable):

	- ABVD x 4-6 cycles without XR

	- ABVD x 2 cycles + XR

 • Early Stage (Unfavorable):

	- ABVD x 4 cycles + Localized XRT

	- ABVD x 6 cycles

 • Advanced Stage:

	- ABVD

	- Stanford V

	- Escalated BEACOPP



#Hodgkins #lymphoma #diagnosis #classification #hematology #oncology #management