Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- linfadenopatía
Other diagnostic factors
- episodios de fiebre inexplicable
- sudores nocturnos
- pérdida de peso
- disnea
- tos
- dolor torácico
- síndrome de la vena cava superior (SVCS)
- dolor abdominal
- prurito
- dolor inducido por el alcohol en los sitios afectados
- hepatomegalia y/o esplenomegalia
- agrandamiento amigdalino
Risk factors
- edad 20-34 años y >55 años
- antecedentes de una infección por virus de Epstein-Barr (VEB)
- antecedentes familiares de linfoma de Hodgkin
- adultos jóvenes de una clase socioeconómica más alta
- tipos de antígenos leucocitarios humanos (ALH)
- linaje judío
Diagnostic investigations
1st investigations to order
- hemograma completo (HC) con diferencial
- perfil metabólico completo (PMC)
- velocidad de sedimentación globular (VSG)
- pruebas de función tiroidea
- cribado del VIH, la hepatitis B y la hepatitis C
- radiografía del tórax (RT)
- exploración por tomografía por emisión de positrones (TEP)/TC
- exploración con galio
- TC con contraste (cuello, tórax, abdomen, pelvis)
- biopsia escisional de ganglio linfático o biopsia central
- estudios inmunohistoquímicos
Investigations to consider
- biopsia de médula ósea
- ecocardiograma o ventriculografía con radionúclidos (MUGA)
- pruebas funcionales respiratorias
Treatment algorithm
LH clásico temprano (etapas I a II): enfermedad favorable y destinado a modalidad de tratamiento combinado
LH clásico temprano (etapas I a II): enfermedad favorable y destinado a quimioterapia en solitario
LH clásico temprano (etapas I a II): enfermedad desfavorable (no voluminosa o voluminosa) y destinada a una modalidad de tratamiento combinado
LH clásico temprano (etapas I a II): enfermedad desfavorable (no voluminosa) y destinada únicamente a quimioterapia
LH clásico temprano (etapas I a II): enfermedad desfavorable (voluminosa) y destinada únicamente a quimioterapia
LH clásico avanzado (etapa III a IV): destinado a terapia de inducción estándar (quimioterapia)
LH clásico avanzado (etapa III a IV): destinado a terapia de inducción estándar (quimioinmunoterapia)
LH clásico avanzado (etapa III a IV): destinado a quimioterapia intensiva de inducción
NLPHL asintomático temprano (etapa IA a IIA), enfermedad no voluminosa
NLPHL asintomático temprano (etapas IA a IIA), enfermedad voluminosa; y NLPHL sintomático temprano (etapas IB a IIB)
NLPHL avanzado (etapa III a IV)
LH clásico refractario o recidivante
NLPHL refractario o recidivante
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
- Linfoma no Hodgkin (LNH)
- Linfadenopatía causada por otras neoplasias malignas
- Mononucleosis infecciosa
More DifferentialsGuidelines
- Suspected cancer: recognition and referral
- NCCN clinical practice guidelines in oncology: Hodgkin lymphoma
More Guidelines
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