Lymphoma- Hodgkin Lymphoma -adults

Hodgkin Lymphoma (HL)

What is the Lymphatic System?

The lymphatic system is a network of lymph nodes, lymphatic organs, and lymph vessels that helps the body fight infections and disease. It circulates lymph, a fluid containing lymphocytes (white blood cells essential for immune response).

Types of Lymphocytes:

• B cells: Produce antibodies to fight infections.

• T cells: Destroy infected cells and help B cells in antibody production.

Key components of the lymphatic system include:

• Lymph nodes: Found in the neck, armpits, chest, abdomen, and groin.

• Spleen: Filters blood and produces lymphocytes.

• Thymus: Develops T-cells for immunity.

• Tonsils: Trap bacteria from the mouth and nose.

What is Hodgkin Lymphoma?

Hodgkin Lymphoma (HL) is a cancer of the lymphatic system where healthy lymphocytes grow uncontrollably, forming tumors. This cancer primarily affects the lymph nodes in the neck, chest (mediastinum), armpits, or groin but can also spread to the lungs, liver, bone marrow, spleen, or bones.

Types of Hodgkin Lymphoma

1. Classic Hodgkin Lymphoma (cHL):

• Accounts for 95% of HL cases.

• Characterized by the presence of Reed-Sternberg cells (abnormal large lymphocytes).

• Subtypes of cHL:

• Nodular Sclerosis Hodgkin Lymphoma:

• The most common subtype, accounting for 80% of cHL cases.

• Often affects young women and occurs in the mediastinum.

• Mixed Cellularity Hodgkin Lymphoma:

• More common in older adults.

• Found in the abdomen, containing a variety of cells including Reed-Sternberg cells.

• Lymphocyte-rich cHL:

• Accounts for 6% of cases, primarily affecting men.

• Usually found outside the mediastinum.

• Lymphocyte-depleted cHL:

• The rarest subtype, occurring in 1% of cases.

• Common in older adults or individuals with AIDS.

2. Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL):

• Occurs in 5% of HL cases.

• Found mainly in the neck, armpits, or groin.

• Similar to B-cell non-Hodgkin lymphoma with popcorn-shaped cells that express CD20 protein.

Statistics

• India reports 9,221 cases of HL annually, ranking 26th among cancers.

• The 5-year survival rate for HL in the United States is 89%.

Risk Factors

• Age: Common between 15-40 years and above 55 years.

• Gender: More common in men, except for nodular sclerosis subtype, which is more frequent in women.

• Family history: Higher risk among siblings of individuals with HL.

• Epstein-Barr Virus (EBV): Present in 25% of cHL cases.

Symptoms

• Painless swelling of lymph nodes in the neck, armpits, or groin.

• Unexplained fever.

• Weight loss without any known cause.

• Night sweats (profuse sweating).

• Itching all over the body.

• Pain in lymph nodes after consuming alcohol.

• Shortness of breath, cough, or chest pain (if the mediastinum is affected).

A vs B Symptoms:

• A Stage: No systemic symptoms.

• B Stage: At least one of the following symptoms:

1. Unexplained weight loss of 10% or more in 6 months.

2. Fever higher than 100.4°F (38°C).

3. Severe night sweats.

Diagnosis

• Physical examination.

• Blood tests: CBC, ESR, liver, and kidney function tests.

• Biopsy: Sample of affected lymph nodes is removed for microscopic examination. Reed-Sternberg cells confirm the diagnosis.

• Imaging tests:

• CT Scan

• PET-CT

• MRI

• Lung function tests and heart evaluations.

• Bone marrow aspiration (if the cancer has spread to the bone marrow).

Treatment for Hodgkin Lymphoma

1. Chemotherapy

• Uses drugs to destroy cancer cells.

• Common first-line chemotherapy regimens:

• ABVD: Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine.

• AAVD: ABVD with Brentuximab Vedotin replacing Bleomycin.

• BEACOPP: Bleomycin, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Procarbazine, and Prednisone.

• Second-line chemotherapy:

• ICE: Ifosfamide, Carboplatin, and Etoposide.

• ESHAP/DHAP: High-dose Cytarabine and Cisplatin with steroids.

• Brentuximab Vedotin and Bendamustine are used if cancer recurs.

Side effects: Fatigue, infections, nausea, hair loss, and tingling in hands or feet.

2. Immunotherapy

• Checkpoint inhibitors help the immune system target cancer cells.

• Common drugs:

• Nivolumab (Opdivo)

• Pembrolizumab (Keytruda)

• Used for recurrent or refractory HL, especially after stem cell transplantation.

3. Radiation Therapy

• High-energy radiation is used to kill cancer cells.

• Types of radiation therapy:

• Involved-site radiation therapy.

• Intensity-modulated radiation therapy (IMRT).

• Proton therapy.

Side effects: Skin irritation, fatigue, sore throat, or cough (depending on the treatment site).

4. Bone Marrow / Stem Cell Transplantation

• Used if cancer persists after initial treatment or returns.

• Types:

• Autologous transplant: Uses the patient’s stem cells.

• Allogeneic transplant: Uses donor stem cells.

Follow-up Care

Regular follow-ups are essential to monitor for recurrence and manage side effects.

• Physical exams, blood tests, and imaging scans are done at scheduled intervals.

• Managing long-term side effects ensures better quality of life post-treatment.

Hodgkin Lymphoma (HL) is highly treatable, with modern therapies offering excellent outcomes. Early diagnosis, effective chemotherapy regimens, and advances in immunotherapy and stem cell transplantation have significantly improved survival rates. Regular follow-up care helps manage recurrence risks and long-term side effects.

‍