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Hodgkin Lymphoma

A malignant disease characterized by enlargement of the lymph nodes, spleen, and general lymphoid tissue.

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(Source: NIH - National Library of Mediciine)

About Hodgkin Lymphoma

Adult Hodgkin Lymphoma

Adult Hodgkin lymphoma is a type of cancer that develops in the lymph system, part of the body's immune system.

The lymph system is made up of the following:

Childhood Hodgkin Lymphoma

Childhood Hodgkin lymphoma is a type of cancer that develops in the lymph system, which is part of the body's immune system....Read more about Childhood Hodgkin Lymphoma

What works? Research summarized

Evidence reviews

Comparison of the two international standards of chemotherapy for patients with early unfavourable or advanced stage Hodgkin lymphoma

Hodgkin lymphoma is a malignancy of the lymphatic system. It is one of the most common cancers in young adults, particularly in their third decade of life, but it occurs also in children and elderly people. Within the last fifty years it has become one of the most curable forms of cancer. To find the best treatment with the greatest efficacy and least toxicity is the most important challenge in treating Hodgkin lymphoma. There are two international standards for the treatment of early unfavourable or advanced stage Hodgkin lymphoma: chemotherapy with escalated BEACOPP (bleomycin/etoposide/doxorubicin/cyclophosphamide/vincristine/procarbazine/prednisone) regimen initiated by the German Hodgkin Study Group (GHSG) and chemotherapy with ABVD (doxorubicin/ bleomycin/ vinblastine/ dacarbazine) regimen, which is widely used because it has been proven to be effective, well tolerated and easy to administer. We aimed to clarify the advantages and disadvantages of both treatments by comparing the chance of survival (overall survival), the chance of recurrence of the tumour and the frequencies of adverse events after treatment in patients with early unfavourable stage or advanced stage Hodgkin lymphoma.

Treatment of early stage Hodgkin lymphoma

Hodgkin lymphoma is a malignancy of the lymphatic system, first described by Thomas Hodgkin. It can occur in children and adults, but it is more common in the third decade of life. It is one of the most curable forms of cancer. Clinically speaking, there are four stages of Hodgkin lymphoma. Generally, stages I and II are considered as early stage Hodgkin lymphoma and stages III and IV as advanced stage Hodgkin lymphoma. Using risk factors such as presence or absence of bulky disease, age, erythrocyte sedimentation rate and presence or absence of B symptoms, such as night sweats or fever, early stage Hodgkin lymphoma is further classified into early favourable and early unfavourable stages. Treatment options for Hodgkin lymphoma are chemotherapy, radiotherapy or chemotherapy plus radiotherapy. Nowadays chemotherapy plus radiotherapy to involved areas is considered as standard treatment for patients with early stage Hodgkin lymphoma. Radiotherapy has comparatively more treatment related late side effects than chemotherapy, including second malignancies. Perhaps, patients with early stage Hodgkin lymphoma can benefit more by avoiding radiotherapy and can be treated with chemotherapy alone as effectively as with same chemotherapy plus radiotherapy. With this assumption we assess the role of radiotherapy in the treatment of patients with early stage Hodgkin lymphoma. This systematic review compares chance of dying (overall survival) and chance of tumour control in patients with early stage Hodgkin lymphoma after receiving chemotherapy alone or chemotherapy plus radiotherapy. This review includes 1245 patients from five trials in the main analyses. The result of this review is that the addition of radiotherapy to six cycles of chemotherapy is a better treatment option than six cycles of same chemotherapy alone in patients with early stage Hodgkin lymphoma. In terms of five‐year tumour control, approximately 5 patients would be needed to treat with chemotherapy plus radiotherapy to prevent one additional relapse or progression in five years. For survival, 11 to 55 patients (depending on the risk of death) require treatment with additional radiotherapy to prevent one death in five years. Therefore chemotherapy plus radiotherapy (combined modality treatment) is superior to the identical chemotherapy alone in patients with early stage Hodgkin lymphoma.

High‐dose chemotherapy with autologous stem cell transplantation in the first line treatment of aggressive Non‐Hodgkin Lymphoma (NHL) in adults

Aggressive Non‐Hodgkin's Lymphomas (NHLs) are fast growing forms of lymphoma. The most common type is a diffuse large B‐Cell lymphoma (DLCL) but there are several other subtypes of aggressive lymphoma and variants of DLCL, such as centroblastic, immunoblastic or anaplastic large B‐Cell lymphoma. Aggressive NHLs are generally responsive to conventional cancer therapies such as chemotherapy and radiation therapy. In the 1980s, many researchers reported that some patients with diffuse, large‐cell lymphoma, who had not responded to conventional chemotherapy, could be cured with high‐dose chemotherapy and autologous stem cell or bone marrow transplantation. This techniques may be used to treat the cancer, because the high doses of chemotherapy can destroy the patient's bone marrow. Therefore stem cells or marrow is taken from the patient before treatment. The marrow or the stem cells are then frozen, and the patient is given high‐dose chemotherapy with or without radiation therapy to treat the cancer. The marrow or the stem cells that were taken out is then thawed and given back through a needle in a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the marrow given is taken from another person, the transplant is called an allogeneic transplant.On the first decade of study into autologous transplantation for the treatment of aggressive lymphoma, the focus was on the use of this approach to rescue patients after relapse or if the disease already progressed under standard chemotherapy. These encouraging results in relapsed or progressive lymphoma led to the testing of the technique as a primary therapy for the disease. However, it was also important to identify factors that could predict outcome of the therapy for patients with aggressive lymphoma. The International Prognostic Index score (IPI) was established in 1993. This score was designed to better predict outcome of aggressive lymphoma. Based on the number of negative prognostic factors present at the time of diagnosis (age >60 years, stage III/IV disease, elevated lactate dehydrogenase [LDH] level, Eastern Cooperative Oncology Group [ECOG] performance status > 2, more than one extranodal site of disease) four outcome groups (low‐risk, low‐intermediate risk, high‐intermediate risk and high‐risk ) were identified with a 5‐year overall survival ranging from 26% to 73%.

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Summaries for consumers

Comparison of the two international standards of chemotherapy for patients with early unfavourable or advanced stage Hodgkin lymphoma

Hodgkin lymphoma is a malignancy of the lymphatic system. It is one of the most common cancers in young adults, particularly in their third decade of life, but it occurs also in children and elderly people. Within the last fifty years it has become one of the most curable forms of cancer. To find the best treatment with the greatest efficacy and least toxicity is the most important challenge in treating Hodgkin lymphoma. There are two international standards for the treatment of early unfavourable or advanced stage Hodgkin lymphoma: chemotherapy with escalated BEACOPP (bleomycin/etoposide/doxorubicin/cyclophosphamide/vincristine/procarbazine/prednisone) regimen initiated by the German Hodgkin Study Group (GHSG) and chemotherapy with ABVD (doxorubicin/ bleomycin/ vinblastine/ dacarbazine) regimen, which is widely used because it has been proven to be effective, well tolerated and easy to administer. We aimed to clarify the advantages and disadvantages of both treatments by comparing the chance of survival (overall survival), the chance of recurrence of the tumour and the frequencies of adverse events after treatment in patients with early unfavourable stage or advanced stage Hodgkin lymphoma.

Treatment of early stage Hodgkin lymphoma

Hodgkin lymphoma is a malignancy of the lymphatic system, first described by Thomas Hodgkin. It can occur in children and adults, but it is more common in the third decade of life. It is one of the most curable forms of cancer. Clinically speaking, there are four stages of Hodgkin lymphoma. Generally, stages I and II are considered as early stage Hodgkin lymphoma and stages III and IV as advanced stage Hodgkin lymphoma. Using risk factors such as presence or absence of bulky disease, age, erythrocyte sedimentation rate and presence or absence of B symptoms, such as night sweats or fever, early stage Hodgkin lymphoma is further classified into early favourable and early unfavourable stages. Treatment options for Hodgkin lymphoma are chemotherapy, radiotherapy or chemotherapy plus radiotherapy. Nowadays chemotherapy plus radiotherapy to involved areas is considered as standard treatment for patients with early stage Hodgkin lymphoma. Radiotherapy has comparatively more treatment related late side effects than chemotherapy, including second malignancies. Perhaps, patients with early stage Hodgkin lymphoma can benefit more by avoiding radiotherapy and can be treated with chemotherapy alone as effectively as with same chemotherapy plus radiotherapy. With this assumption we assess the role of radiotherapy in the treatment of patients with early stage Hodgkin lymphoma. This systematic review compares chance of dying (overall survival) and chance of tumour control in patients with early stage Hodgkin lymphoma after receiving chemotherapy alone or chemotherapy plus radiotherapy. This review includes 1245 patients from five trials in the main analyses. The result of this review is that the addition of radiotherapy to six cycles of chemotherapy is a better treatment option than six cycles of same chemotherapy alone in patients with early stage Hodgkin lymphoma. In terms of five‐year tumour control, approximately 5 patients would be needed to treat with chemotherapy plus radiotherapy to prevent one additional relapse or progression in five years. For survival, 11 to 55 patients (depending on the risk of death) require treatment with additional radiotherapy to prevent one death in five years. Therefore chemotherapy plus radiotherapy (combined modality treatment) is superior to the identical chemotherapy alone in patients with early stage Hodgkin lymphoma.

Idelalisib (Zydelig) for non-Hodgkin lymphoma: Overview

Idelalisib (trade name: Zydelig) has been approved in Germany since September 2014 for the treatment of follicular lymphoma or chronic lymphatic leukemia.

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Terms to know

Cancer (Malignant Neoplasm)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body.
Lymph Nodes
A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
Lymphatic System
The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.
Lymphoid
Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop.
Lymphoma
Cancer that begins in cells of the immune system.
Reed-Sternberg Cells
A type of cell that appears in people with Hodgkin disease. The number of these cells increases as the disease advances.
Spleen
An organ that is part of the lymphatic system. The spleen makes lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach.
Tissue
A group of cells that act together to carry out a specific function in the body. Examples include muscle tissue, nervous system tissue (including the brain, spinal cord, and nerves), and connective tissue (including ligaments, tendons, bones, and fat). Organs are made up of tissues.

More about Hodgkin Lymphoma

Photo of an adult woman

Also called: Hodgkin disease, Hodgkin's disease, Hodgkin's lymphoma, HL, HD

See Also: Non-Hodgkin Lymphoma

Other terms to know: See all 8
Cancer (Malignant Neoplasm), Lymph Nodes, Lymphatic System

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