Chapter 105 • Estimated 9060 new cases in United States in 2012 with 1190 deaths • U.S. age-adjusted incidence rate of 2.8 per 100,000 per year • Higher incidence among males than females • Highest incidence in North America and Western Europe • Bimodal age distribution (peaks at 15 to 35 years and then again later in life) • Hodgkin Reed-Sternberg and lymphocyte-predominant (LP) cells derive from germinal center B cells. Hodgkin Reed-Sternberg and LP cells are rare in the lymphoma tissue, and interactions with other cells in the microenvironment may play a role in the pathophysiology of the disease. • In classic Hodgkin lymphoma (HL), Hodgkin Reed-Sternberg cells express CD30 and have lost expression of B-cell markers. • Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) represents a distinct clinicopathological entity characterized by scattered large “popcorn” cells that express CD45 and CD20. • Epstein-Barr virus may be involved in the pathogenesis of some classic HL cases, particularly in tropical areas. • Physical examination with attention to peripheral nodes and spleen • History including presence or absence of pruritus, drenching night sweats, fevers, and significant weight loss • Laboratory evaluation to include complete blood cell count with differential, albumin, and erythrocyte sedimentation rate • Positron emission tomography/computed tomography (PET/CT) • Bone marrow biopsy not indicated in early-stage disease and may no longer be needed in advanced-stage disease in patients undergoing PET • Early-stage non-bulky classic HL • Early-stage classic HL with bulky disease
Hodgkin Lymphoma
Summary of Key Points
Incidence
Biological Characteristics
Staging Evaluation
Primary Therapy
ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy (two to four cycles) with 20 to 30 Gy of involved-field radiation therapy (IFRT) with number of cycles and dose of radiation dictated by high-risk features
Interim PET likely to select patients who benefit most from radiation therapy
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Hodgkin Lymphoma
