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
