Hodgkin lymphoma

Last reviewed: 2 Sep 2023
Last updated: 10 Feb 2023

Summary

Definition

History and exam

Key diagnostic factors

  • lymphadenopathy
More key diagnostic factors

Other diagnostic factors

  • unexplained fevers
  • night sweats
  • weight loss
  • dyspnea
  • cough
  • chest pain
  • superior vena cava syndrome (SVCS)
  • abdominal pain
  • pruritus
  • alcohol-induced pain at involved sites
  • hepatomegaly and/or splenomegaly
  • tonsillar enlargement
Other diagnostic factors

Risk factors

  • age 20-34 years and >55 years
  • history of Epstein-Barr virus (EBV) infection
  • family history of Hodgkin lymphoma
  • young adults from higher socioeconomic class
  • human leukocyte antigen (HLA) types
  • Jewish ancestry
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC 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
More 1st investigations to order

Investigations to consider

  • bone marrow biopsy
  • echocardiogram or multigated acquisition (MUGA) scan
  • pulmonary function tests
More investigations to consider

Treatment algorithm

ACUTE

early (stage I to II) classical HL: favorable disease and intended for combined-modality therapy

early (stage I to II) classical HL: favorable disease and intended for chemotherapy alone

early (stage I to II) classical HL: unfavorable disease (non-bulky or bulky) and intended for combined-modality therapy

early (stage I to II) classical HL: unfavorable disease (non-bulky) and intended for chemotherapy alone

early (stage I to II) classical HL: unfavorable 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

ONGOING

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 miRagen (Viridian) Therapeutics, Seattle Genetics, Merck, Bristol Myers Squibb, and Incyte; and honoraria from Imbrium Therapeutics, Merck, and Seattle Genetics. AM is an author of several articles cited in the topic.

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.

  • Hodgkin lymphoma images
  • Differentials

    • Non-Hodgkin lymphoma (NHL)
    • Lymphadenopathy from other malignancies
    • Infectious mononucleosis
    More Differentials
  • Guidelines

    • NCCN clinical practice guidelines in oncology: pediatric Hodgkin lymphoma
    • NCCN clinical practice guidelines in oncology: management of immunotherapy-related toxicities
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer