Source: Chan A, Yee GC. Lymphomas.
In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM.
Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=8009338.
Accessed August 4, 2012.
- Clonal malignant lymphoid disease of transformed lymphocytes
- Malignant cell known as Reed-Steinberg cell
- Laboratory evidence supports infectious
exposure as potential cause
- Increased risk with
Epstein-Barr virus (EBV)
- Genetic factors
- B-cell transcriptional processes disrupted
expression of B-cell surface markers and production of immunoglobulin
messenger RNA (mRNA).
- Alterations in normal apoptotic pathways favor cell survival
- Malignant Reed–Sternberg cells overexpress nuclear
- Associated with cell proliferation and
- Up-regulated by infections with viral and bacterial pathogens.
- Epstein–Barr virus found in many, but not all,
Hodgkin lymphoma (HL) tumors.
- HL represents <1% of all known cancers in
- Bimodal distribution with first peak in third decade and small
peak occurring after age 50
- Most patients with HL present with painless, rubbery,
enlarged lymph node in supradiaphragmatic area and commonly have
mediastinal nodal involvement.
- Constitutional (B symptoms) in ~25% of all patients
- Drenching night sweats
- Weight loss
Means of Confirmation
- Requires presence of Reed–Sternberg cells in
lymph node biopsy.
- Metabolic panel
- Complete blood count (CBC)
- Erythrocyte sedimentation rate (ESR)
- Chest radiography
- Computed tomography (CT) of chest, abdomen, and pelvis
- Positive emission tomography (PET)
- Integrated PET-CT
- Excisional lymph node biopsy
- Laparoscopy or laparotomy of strategic sites
- Bone marrow aspiration and biopsy with advanced-stage disease
- Based on clinical or pathologic findings
disease (stages, I, II, and IIE) in ~50% of patients
- Advanced disease (stage III or IV) in other half
- 10–15% have metastatic disease (stage IV)
- Maximize curability while minimizing short- and long-term
- Combination chemotherapy is primary treatment modality.
- Therapeutic role of surgery limited, regardless of stage.
- Radiation therapy (RT)
- Early-stage HL treated with combination chemotherapy and RT.
- Advanced-stage HL treated with combination chemotherapy with
or without RT.
- Initial chemotherapy
- Two to eight cycles
of chemotherapy given depending on stage of disease and presence
of risk factors (Tables 1 and 2).
- Salvage chemotherapy
- Treatment options for relapse after initial complete response
- Repeat same regimen
- Non–cross-resistant regimen
- High-dose chemotherapy and autologous hematopoietic stem cell
- Response to salvage therapy depends on:
and site of recurrence
- Previous therapy
- Duration of first remission
- Choice of salvage therapy should be guided by response to
initial therapy and patient’s ability to tolerate therapy.
Table 1. General Treatment
Recommendations for Hodgkin Lymphoma