Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- lymphadenopathy
Other diagnostic factors
- 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
Risk factors
- 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
Diagnostic tests
1st tests to order
- FBC with differential
- comprehensive metabolic panel
- erythrocyte sedimentation rate (ESR)
- thyroid function tests
- screening for HIV, hepatitis B, hepatitis C
- CXR
- PET/CT scan
- gallium scan
- contrast-enhanced CT (neck, chest, abdomen, pelvis)
- excisional lymph node biopsy or core biopsy
- immunohistochemical studies
Tests to consider
- bone marrow biopsy
- echocardiogram or multi-gated acquisition (MUGA) scan
- pulmonary function tests
Treatment algorithm
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
advanced (stage III to IV) classical HL: intended for standard induction therapy (chemotherapy)
advanced (stage III to IV) classical HL: intended for standard induction therapy (chemoimmunotherapy)
advanced (stage III to IV) classical HL: intended for intensive induction 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
Contributors
Authors
Alison Moskowitz, MD
Associate Attending
Lymphoma Service
Memorial Sloan-Kettering Cancer Center
New York City
NY
Disclosures
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.
Acknowledgements
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.
Disclosures
CRK, LRP, and TMZ declare that they have no competing interests.
Peer reviewers
Joachim Yahalom, MD
Radiation Oncologist
Director of Postgraduate Education
Department of Radiation Oncology
Memorial Sloan-Kettering Cancer Center
New York
NY
Disclosures
JY declares that he has no competing interests.
Rebecca Connor, MD
Chief Fellow
Section of Hematology and Oncology
Department of Internal Medicine
Wake Forest University Baptist Medical Center
Winston-Salem
NC
Disclosures
RC declares that she has no competing interests.
Kirit Ardeshna, MD, MA (Cantab), MB, BChir, FRCP, FRCPath
Consultant Haematologist
University College London Hospitals
London
UK
Disclosures
KA declares that he has no competing interests.
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
Eichenauer DA, Aleman BM, André M, et al. Hodgkin lymphoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1;29(4 suppl):iv19-29.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: Hodgkin lymphoma [internet publication].Full text
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
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
- Suspected cancer: recognition and referral
- NCCN clinical practice guidelines in oncology: Hodgkin lymphoma
More Guidelines
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