Hodgkin Lymphoma
Summary of Key Points
Incidence
• Estimated 9060 new cases in United States in 2012 with 1190 deaths
• U.S. age-adjusted incidence rate of 2.8 per 100,000 per year
• Higher incidence among males than females
• Highest incidence in North America and Western Europe
• Bimodal age distribution (peaks at 15 to 35 years and then again later in life)
Biological Characteristics
• Hodgkin Reed-Sternberg and lymphocyte-predominant (LP) cells derive from germinal center B cells. Hodgkin Reed-Sternberg and LP cells are rare in the lymphoma tissue, and interactions with other cells in the microenvironment may play a role in the pathophysiology of the disease.
• In classic Hodgkin lymphoma (HL), Hodgkin Reed-Sternberg cells express CD30 and have lost expression of B-cell markers.
• Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) represents a distinct clinicopathological entity characterized by scattered large “popcorn” cells that express CD45 and CD20.
• Epstein-Barr virus may be involved in the pathogenesis of some classic HL cases, particularly in tropical areas.
Staging Evaluation
• Physical examination with attention to peripheral nodes and spleen
• History including presence or absence of pruritus, drenching night sweats, fevers, and significant weight loss
• Laboratory evaluation to include complete blood cell count with differential, albumin, and erythrocyte sedimentation rate
• Positron emission tomography/computed tomography (PET/CT)
• Bone marrow biopsy not indicated in early-stage disease and may no longer be needed in advanced-stage disease in patients undergoing PET
Primary Therapy
• Early-stage non-bulky classic HL
ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy (two to four cycles) with 20 to 30 Gy of involved-field radiation therapy (IFRT) with number of cycles and dose of radiation dictated by high-risk features
Interim PET likely to select patients who benefit most from radiation therapy
• Early-stage classic HL with bulky disease
