Hodgkin Lymphoma (HL) is a malignant lymphoma characterised by the presence of Reed-Sternberg cells within an inflammatory background. It is an important and potentially curable haematological malignancy, especially in younger patients.

Epidemiology

• Bimodal age distribution: Peaks in young adults (15-35 years) and older adults (>55 years).
• Slight male predominance.
• Risk factors: Epstein-Barr Virus (EBV) infection, family history, immunosuppression (e.g., HIV, post-transplant patients).

Clinical Presentation

• Painless lymphadenopathy (most commonly cervical, supraclavicular, or mediastinal).
• B symptoms (fever >38°C, drenching night sweats, weight loss >10% in 6 months) indicate advanced disease.
• Pruritus and alcohol-induced lymph node pain are less common but characteristic.
• Splenomegaly, hepatomegaly, or organ involvement in advanced disease.

Diagnosis

• Lymph node biopsy (excisional preferred) showing Reed-Sternberg cells in a mixed inflammatory background.
• Immunohistochemistry: CD30+ and CD15+.
• Staging investigations:
  • CT/PET scan – Determines extent of disease.
  • Bone marrow biopsy – Not routinely required
  • Blood tests: ESR, LDH, FBC (may show anaemia, leukocytosis, eosinophilia).

Staging (Ann Arbor Classification)

• Stage I: Single lymph node region.
• Stage II: Multiple lymph node regions on the same side of the diaphragm.
• Stage III: Lymph nodes on both sides of the diaphragm.
• Stage IV: Disseminated involvement (e.g., liver, bone marrow).

Management

• Early-stage disease (I-II): Further classified into favourable and unfavourable based on factors such as bulky disease, high ESR, extranodal involvement, and multiple nodal sites.
• Advanced-Stage disease (IIB-IV)
• Treatment options include chemotherapy and radiotherapy.
• ABVD or escalated BEACOPP: depending on stage and fitness of patient.
• Relapsed/refractory disease: Salvage chemotherapy, autologous stem cell transplant, and checkpoint inhibitors (e.g., pembrolizumab) for resistant cases.

Prognosis

• Highly curable, with >90% survival in early-stage disease.
• Poorer prognosis with B symptoms, bulky disease, and extranodal involvement.

Hodgkin Lymphoma is a curable malignancy with well-defined treatment strategies. Prompt diagnosis and staging are key to achieving excellent outcomes.

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