Hodgkin’s Disease

Published on 21/03/2015 by admin

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Last modified 21/03/2015

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Chapter 36 Hodgkin’s Disease

PATHOPHYSIOLOGY

Hodgkin’s disease is a malignancy of the lymphoid system. The cause remains unknown. Hodgkin’s disease is seen with a higher frequency in children with inherited immune deficiency syndromes. There has also been an association for some patients following infection with Epstein-Barr virus. Hodgkin’s disease is characterized by a proliferation of Reed-Sternberg cells that are surrounded by a pleomorphic infiltrate of reactive cells. Although no tissue is exempt from involvement, Hodgkin’s disease primarily affects nodal or lymphatic sites. The liver, the spleen, the bone marrow, and the lungs may also be involved. Hodgkin’s disease is classified according to the predominating type of cells and is characterized by four histologic states: (1) lymphocytic predominance (rare in children, often very localized disease requiring minimal therapy), (2) nodular sclerosis (most common in children), (3) mixed cellularity, and (4) lymphocytic depletion.

High survival rates have been achieved in children with Hodgkin’s disease as a result of improved staging procedures, combined therapies, and advances in supportive care. The 5-year relative survival rate for children under age 15 has gone from 78% in 1976 to 95% in 2001. However, cure often comes with significant cost secondary to the late effects of therapy. Over the past 2 decades, there has been a focus on lowering the doses and fields of radiation and limiting the exposure of certain chemotherapeutic agents. Newer treatment protocols are also evaluating therapy that is based on the individual’s response to initial treatment. If there is an early complete response to treatment, then the remaining therapy is less intense. The hope is that cure rates can be maintained with fewer long-term side effects. Early results have been encouraging.

COMPLICATIONS