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Perth Haematology :: Dr Steven Ward

Hodgkin's Disease

 

Introduction:

Hodgkin's Disease was described by Thomas Hodgkin. The disease remains an enigma, with the malignant cell being very difficult to identify. Many of the features of HD are related to reactive changes stimulated by the few truly malignant cells. Reed-Sternberg cells are thought to be the tumour cell.

 

Classification:

Types of Hodgkin's Disease

Classical HD:

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Nodular sclerosis (NS). The lymph nodes in the lower neck, chest and collarbone usually contain normal and reactive lymphocytes and Reed-Sternberg cells separated by bands of scar-like tissues. NS accounts for 60-70% of Hodgkin's cases. NS appears to account for the increase in Hodgkin's cases in recent years

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Lymphocyte predominant (LP). The lymph nodes are composed largely of reactive lymphocytes and malignant L&H cells which have a "popcorn" appearance and very few Reed-Sternberg cells. LP accounts for 5% of Hodgkin's cases and affects more men than women.

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Mixed cellularity (MC). The lymph nodes usually contain Reed-Sternberg cells and inflammatory cells. MC accounts for 20-30% of Hodgkin's cases.

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Lymphocyte depleted (LD). There are two different variations of this classification: one with sheets of differing malignant cells; the other with few Reed-Sternberg cells and lymphocytes with scar-like tissue. Accounts for about 5% of Hodgkin's cases.

 

 

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Nodular lymphocyte predominant (NLP) Hodgkin's lymphoma. NLP is in a category of its own. Typical Reed-Sternberg cells are rare to non-existent; instead variants called L & H cells (colloquially "popcorn cells") are seen. Additional distinctive clinical features setting apart nodular lymphocyte predominance HL include:
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an indolent, though relapsing, course with an excellent prognosis;

bulletoccasional cases relapsing as high-grade B-cell non-Hodgkin's lymphoma;
bulleta peak incidence in males in their 30's and 40's, without the bimodal age pattern of classic HL;
bulleta greater tendency to be restricted to cervical lymph nodes.

 

Stages of Hodgkin's Lymphoma: (Ann Arbor Classification - see NHL pages)

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Stage I involves one lymph node region

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Stage II involves two or more lymph node regions on the same side of the diaphragm

bullet Stage III involves lymph nodes on both sides of the diaphragm
bullet Stage IV involves other organs besides the lymph system

   

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The letter "E" is used after the stage to designate disease spread to other areas (bone marrow, lung, etc.)

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Staging is also dependent on whether the patient has had a group of systemic symptoms including night sweats, fever, or weight loss. Patients who have had one or more of these are grade "B" while patients who have none grade "A". Itching and back pain are not symptoms which rate the "B" designation but can be common in many cases where "B" symptoms are evident.

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Progressive Disease - the disease progresses (grows) while the patient is in treatment (usually treatment reduces tumors).

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Recurrent (Relapsed) Disease - Recurrent disease means that the cancer has come back after it has been treated. It may come back in the area where it first started or in another part of the body.

 

 

 

Survival Rates by Stage

Stage

5-year relative survival rate

 

I

90% to 95%

5 year survival rates for Hodgkin's by stage although your individual case can differ (for example, treatments get better over time)

 

II

90% to 95%

III

85% to 90%

IV

80% to 85%

 

 

Risk Factors for Early Stage Hodgkins Lymhpoma

Favourable

≤3 node sites involved

Age ≤ 40 years

ESR ≤ 70 mmHg

Unfavourable

>3 node sites involved

Age > 40 years

ESR > 70 mmHg

Large mediastinal mass

 

Hasenclever Prognostic index for Advanced Hodgkin Lymphoma

Albumin <40g/L

 

No of Factors

DFS

Hb < 105g/L

 

0

84%

Male

 

1

77%

Age ≥45 years

 

2

67%

Stage IV

 

3

60%

WCC >15.0 x 109/L

 

4

51%

Lymphopenia <0.6  or <8%

 

≥5

42%

 

Treatment

Treatment for Hodgkin Disease depends on the stage (Extent) of the disease and the presence of bulky disease sites. See also the Chemotherapy Section of this website.

 

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Stage I & II disease is usually treated by combined chemotherapy  (ABVD x 4) with radiation to the affected site. This approach minimises the exposure to both chemotherapy agents and radiation.

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Stage III & IV disease is most often treated with chemotherapy alone. with radiation to any bulky site.

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ABVD x 6 or 8

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or BEACOPP x 8

 

Hodgkin Disease was the fist human cancer to be successfully treated and cured. The success rates are very good. Even with relapsed disease it often continues to respond to therapy.

 

The aim nowadays is to try to cure the disease with the minimum treatment necessary, thus avoiding potential side effects from chemotherapy or radiation.

 

 

See also HD Treatment Algorithm and Relapse Algorithm