HODGKINS LYMPHOMA

Clinical features
1. Bimodal age
distribution:
- Young adults (20-30
years)
- Elderly (50 years)
may occur at any
age
2. M>F
3. Lymphadenopathy:
- Most often cervical
region
- Asymmetrical,
discrete
- Painless, non tender
- Elastic character on
palpation (rubbery)
- not adherent to skin
- fluctuate in size
- contiguous spread
via lymphatic chain
eg involvement of
abdominal and
thoracic LN
- extra nodal diseaserare
- Hepatosplenomegal
y

Symptoms
1. Constitutional
symptoms (B
symptoms)
- Night
symptoms
- Sustained
fever > 38
degree
Celsius
- Loss of
weight >
10% of
body
weight
2. Fever
sometimes
cyclical ( Pelebstein fever)
3. Pain at the
site of disease
after drinking
alcohol
4. Pallor
5. Pruritis
6. Symptoms of
Bulky (>10cm
disease)

Investigations
1. CBP :
Anemia
(normochromic/normocytic),
eosinophilia, neutrophilia,
lymphopenia
2. ESR raised
3. LFT increase (liver infil/
obs at porta hepatis)
4. RFT prior to treatment
5. Urate, Ca
6. LDH increase adverse
prognosis
7. CXR- mediastinal mass
8. CT thorax/ abdomen.
Pelvis for staging
9. Other : Gallium scan, PET,
lymphagiography,
Laporotomy
10.LN FNAC/ biopsy:
- Malignant REEDSTERNBERG (RS ) cell:
bi nucleate ccell with
a prominent
nucleolus. Derived
from B cell, at an early
stage of differentiation
- Reactive background
of eosinophils,
lymphocytes, plasma
cells

Staging
Stage 1: Involvement
of single LN region (l)
or extra lymphatic
site (IAE)
Stage II: 2 or more LN
regions involved (II)
or an extra lymphatic
site and lymph node
regions on the same
side of diaphragm
STAGE III: invlvmnt of
LN regions on both
sides of diaphragm,
with (IIIE) or without
(III) localised extra
lymphatic invovlemnt
or involvement of
spleen (IIS) or both
(IIS E)
STAGE IV- involve
outside LN areas
(liver, bone marrow)
(A- Absence of B
symptoms
(B- B symptoms

Treatment
1. RT
2. Chemo
3. BMT/ SCT
4. Antibody
treatment :
Rituximab
tarfet CD-20
5. Supportive

Fibrous tissue

TREATMENT GUIDELINES
Indications for RT
1. Stage 1 disease

Indications for CT
1. All with B symptoms

2. Stage II disease with 3 or lesser areas

3. For Bulky disease
4. For pressure problems
Radiotherapy
Chemotherapy
Every 3-4 weeks
6-8 cycles;
Either alone, or in combination with radiotherapy
Chemotherapy + Radiotherapy (for bulky disease or
palliation of symptoms)
CHEMOTHERAPY
MOPP

ABVD

2. Stage II disease with >3 areas involved

3. Stage III and IV disease

Stage IA, Stage IIA with 3 or <3 areas involved

Stage IB, Stage II A with > 3 areas, Stage IIB

Stage III & IV

Nitrogen Mustard
Vincristine (Oncovin)
Procarbazine
Prednisolone
Adriamycin
Bleomycin
VInblastin
Dacarbazine

Higher dose for relapse or younger pts with poor prognostiv

feature
Prognosis
Overall 10 yr survival 80%
In long term survivors there is a risk of
1. Secondary malignancy : (leukemia, NHL) , solid tumors Lung breast
2. Infections
3. Cardiac, pulmonary, endocrinal abnormalities

International Prognostic Index (IPI)

1.
2.
3.
4.
5.

Age
Advanced stage disease
Performance status
Elevated LDH
Presence of extra nodal disease