Hodgkin's lymphoma
Summary
Definição
História e exame físico
Principais fatores diagnósticos
- presence of risk factors
- lymphadenopathy
Outros fatores diagnósticos
- unexplained fevers
- night sweats
- weight loss
- dyspnoea
- cough
- chest pain
- superior vena cava syndrome (SVCS)
- abdominal pain
- pruritus
- alcohol-induced pain at involved sites
- hepatomegaly and/or splenomegaly
- tonsillar enlargement
Fatores de risco
- age 20-34 years and >55 years
- history of Epstein-Barr virus (EBV) infection
- family history of Hodgkin's lymphoma
- young adults from higher socio-economic class
- human leukocyte antigen (HLA) types
- Jewish ancestry
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- FBC with differential
- comprehensive metabolic panel
- erythrocyte sedimentation rate (ESR)
- thyroid function tests
- screening for HIV, hepatitis B, hepatitis C
- CXR
- PET/CT scan
- contrast-enhanced CT (neck, chest, abdomen, pelvis)
- excisional lymph node biopsy or core biopsy
- immunohistochemical studies
Investigações a serem consideradas
- bone marrow biopsy
- echocardiogram or multi-gated acquisition (MUGA) scan
- pulmonary function tests
Algoritmo de tratamento
early (stage I to II) classical HL: favourable disease and intended for combined-modality therapy
early (stage I to II) classical HL: favourable disease and intended for chemotherapy alone
early (stage I to II) classical HL: unfavourable disease (non-bulky or bulky) and intended for combined-modality therapy
early (stage I to II) classical HL: unfavourable disease (non-bulky) and intended for chemotherapy alone
early (stage I to II) classical HL: unfavourable disease (bulky) and intended for chemotherapy alone
early (stage I to II) classical HL: unfavourable disease and intended for alternative induction therapy
advanced (stage III to IV) classical HL: intended for intensive induction chemotherapy
advanced (stage III to IV) classical HL: intended for standard induction therapy (chemoimmunotherapy)
advanced (stage III to IV) classical HL: intended for standard induction therapy (chemotherapy)
asymptomatic early (stage IA to IIA) NLPHL, non-bulky disease
asymptomatic early (stage IA to IIA) NLPHL, bulky disease; and symptomatic early (stage IB to IIB) NLPHL
advanced (stage III to IV) NLPHL
refractory or relapsed classical HL
refractory or relapsed NLPHL
Colaboradores
Autores
Alison Moskowitz, MD
Associate Attending
Lymphoma Service
Memorial Sloan-Kettering Cancer Center
New York City
NY
Divulgaciones
AM has received research support from ADC Therapeutics, Beigene, Miragen, Seattle Genetics, Merck, Bristol-Myers Squibb, Incyte, and SecuraBio. AM has received honoraria from Seagen, Affimed, Astra Zeneca, Bio Ascend, Imbrium Therapeutics L.P./Purdue, Janpix Ltd., Merck, Seattle Genetics, Pfizer, Tessa Therapeutics and Takeda. AM is an author of several references cited in this topic.
Agradecimientos
Dr Alison Moskowitz would like to gratefully acknowledge Dr Chris R. Kelsey, Dr Leonard R. Prosnitz, and Dr Timothy M. Zagar, the previous contributors to this topic.
Divulgaciones
CRK, LRP, and TMZ declare that they have no competing interests.
Peer reviewers
Snegha Ananth, MBBS
Assistant Professor
Division of Oncology & Hematology
University of Nebraska Medical Center
Omaha
NE
Disclosures
SA declares that she has no competing interests.
Christopher D'Angelo, MD
Assistant Professor
Division of Oncology & Hematology
University of Nebraska Medical Center
Omaha
NE
Disclosures
CDA declares that he has received consulting fees from Abbvie, Beigene, Genmab, Curis Inc, Bristol Myers Squibb.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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 Sep 20;32(27):3059-68.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: Hodgkin lymphoma [internet publication].Full text
Eyre TA, Cwynarski K, d'Amore F, et al. Lymphomas: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 1 Aug 2025:S0923-7534(25)00911-1.Full text Abstract
Follows GA, Barrington SF, Bhuller KS, et al. Guideline for the first-line management of classical Hodgkin lymphoma - a British Society for Haematology guideline. Br J Haematol. 2022 Jun;197(5):558-72.Full text Abstract
McKay P, Fielding P, Gallop-Evans E, et al. Guidelines for the investigation and management of nodular lymphocyte predominant Hodgkin lymphoma. Br J Haematol. 2016 Jan;172(1):32-43.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Non-Hodgkin's lymphoma (NHL)
- Lymphadenopathy from other malignancies
- Infectious mononucleosis
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: Hodgkin lymphoma
- Suspected cancer: recognition and referral
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer