Hodgkin lymphoma (HL) most commonly presents with painless cervical and/or supraclavicular lymphadenopathy in a young adult.
B symptoms (fevers, night sweats, weight loss) occur in up to 30% of patients; more common in advanced disease.
Imaging, preferably PET/CT, is essential to determine extent of disease. Biopsy is necessary to confirm diagnosis.
Combined-modality therapy (chemotherapy plus radiation therapy) is highly effective for early (stage I or stage II) classical HL, but it is associated with toxicity and long-term complications. PET-adapted treatment approaches for early-stage disease balance efficacy and safety through avoidance of radiation therapy in chemosensitive patients.
Chemotherapy is the cornerstone of treatment for advanced (stage III or stage IV) classical HL.
Radiation therapy is recommended for patients with early-stage nodular lymphocyte-predominant HL (NLPHL). Patients with advanced-stage NLPHL can be treated with rituximab plus chemotherapy. Observation may be appropriate for asymptomatic patients with early- or advanced-stage NLPHL.
Hodgkin lymphoma (HL), also referred to as Hodgkin disease, is an uncommon hematologic malignancy arising from mature B cells. It is characterized by the presence of Hodgkin cells and Reed-Sternberg cells.
The topic focuses on the diagnosis and management of adults with HL.
History and exam
Key diagnostic factors
Other diagnostic factors
- unexplained fevers
- night sweats
- weight loss
- chest pain
- superior vena cava syndrome (SVCS)
- abdominal pain
- alcohol-induced pain at involved sites
- hepatomegaly and/or splenomegaly
- tonsillar enlargement
- 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
1st investigations to order
- CBC with differential
- comprehensive metabolic panel
- erythrocyte sedimentation rate (ESR)
- thyroid function tests
- screening for HIV, hepatitis B, hepatitis C
- PET/CT scan
- gallium scan
- contrast-enhanced CT (neck, chest, abdomen, pelvis)
- excisional lymph node biopsy or core biopsy
- immunohistochemical studies
Investigations to consider
- bone marrow biopsy
- echocardiogram or multigated acquisition (MUGA) scan
- pulmonary function tests
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
refractory or relapsed classical HL
refractory or relapsed NLPHL
- Non-Hodgkin lymphoma (NHL)
- Lymphadenopathy from other malignancies
- Infectious mononucleosis
- NCCN clinical practice guidelines in oncology: pediatric Hodgkin lymphoma
- NCCN clinical practice guidelines in oncology: management of immunotherapy-related toxicities
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