Haematology for Doctors

Category: Hodgkin Lymphoma

  • A brief introduction to Hodgkin Lymphoma

    A brief introduction to Hodgkin Lymphoma

    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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