Medicine
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Lymphoma

Lymphoma

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Hodgkin Lymphoma

 

Pathology:                    Clonal proliferation of abnormal B-lymphocytes (Reed-Sternberg cells) along with the production of other abnormal T- and B-lymphocytes in an uncontrolled manner.

 

Aetiology:                    The exact cause of Hodgkin lymphoma is unknown. However, certain factors may contribute to its development, such as infection with the Epstein-Barr virus, being HIV-positive, and having a first-degree relative who is affected with the disease. Additionally, there is an increased risk of Hodgkin lymphoma in adolescents and young adults.

 

Symptoms:                   Common symptoms of Hodgkin lymphoma, known as the "B-symptoms," may include weight loss, anorexia, night sweats, fever, fatigue, and itching. Additionally, individuals may experience painful lymph nodes upon drinking alcohol.

 

Signs:                              Common signs of Hodgkin lymphoma include painless cervical lymphadenopathy, enlargement of the liver and spleen (hepatomegaly and splenomegaly), blockage of the superior vena cava, bronchial obstruction, pleural effusion, and infection (such as shingles).

 

Investigations:          

  • Bloods: A complete blood count may reveal a normochromic normocytic anemia, thrombocytosis, lymphocytopenia, and an elevated erythrocyte sedimentation rate and alkaline phosphatase.
  • Imaging: A chest, abdomen, and pelvis CT scan may be used for staging of Hodgkin lymphoma using the Ann Arbor System.
  • Bone Marrow Aspirate: This may also be used for staging using the Ann Arbor System.

 

Treatment:                  

  • Medical: Treatment for Hodgkin lymphoma may include chemotherapy and, in cases of relapse of the disease, an autologous stem cell transplant. In cases of refractory or multiply relapsed disease, an allogeneic stem cell transplant may be necessary.

 

Complications:          Early: Early complications of Hodgkin lymphoma may include infections, bone marrow failure, and organ damage.

Late: Late complications may include reduced fertility, premature menopause, secondary malignancy, lung fibrosis, and lung and thyroid toxicity.

 

Prognosis:                   The prognosis of Hodgkin lymphoma depends upon the stage of the disease at the time of diagnosis. For example, patients in stage I or II (with good risk classical Hodgkin lymphoma) may have a 5-year overall survival rate of 95%, while those in stage III or IV (with poor risk classical Hodgkin lymphoma) may have a 5-year overall survival rate of 59%.

 

 

Text Box: Ann Arbor Staging For Hodgkin’s Lymphoma     Stage I: Confined to single LN  Stage II: 2 or more LN groups confined to one side of the diaphragm  Stage III: 2 or more LN groups on both sides of the diaphragm  Stage IV: Involvement of extralymphatic sites (e.g. bone marrow)    A = Absence of systemic symptoms  B = Presence of systemic symptoms

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