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Chapter 23: Lymphoma, Hodgkin

Michael Fuchs; Dennis A. Eichenauer; Volker Diehl

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INTRODUCTION

Epidemiology

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Epidemiology
Incidence: 9,190 (male: 5,070; female: 4,120. Estimated new cases for 2014 in the United States) 3.2 per 100,000 males; 2.4 per 100,000 females
Deaths: Estimated 1,180 in 2014 (male: 670; female: 510)
Median age: 38 years
Male to female ratio: 1.2:1

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

Pathology

Since 1944, several classifications have been proposed for Hodgkin lymphoma (HL). Currently, the World Health Organization (WHO) Classification of Hematologic Malignancies is used:

  1. Lymphocyte predominant, nodular (NLPHL) (5%)

  2. Classic

    1. Lymphocyte-rich (LRCHL) (5%)

    2. Nodular sclerosis (NSHL) (60–80%)

    3. Mixed cellularity (MCHL) (15–30%)

    4. Lymphocyte depleted (LDHL) (1%)

    5. Unclassifiable (<1%)

Jaffe ES, Harris NL, Stein H, Vardiman JW, eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press, 2001

Work-up

  1. History and physical exam

  2. Laboratory tests: CBC with differential, ESR, electrolytes, albumin, liver function tests, mineral panel, LDH

  3. HIV and hepatitis B and C serologies as clinically indicated

  4. Chest x-ray (PA and lateral)

  5. CT scan of chest, abdomen, and pelvis (and neck in selected cases)

  6. Positron emission tomography (PET) scan if clinically indicated (equivocal CT)

  7. Bone marrow aspirate and biopsy

  8. Pulmonary function tests

  9. Echocardiogram or MUGA scan to determine cardiac ejection fraction

  10. Excisional lymph node biopsy to completely assess lymph node architecture is required at initial diagnosis. Fine-needle aspiration biopsy alone is not desirable for the initial diagnosis of lymphoma

  11. Fertility counseling, if appropriate

Five-Year Survival Rate

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Five-Year Survival Rate
NLPHL 90% (10 years)
Classic HL 70-80%

Jaffe ES, Harris NL, Stein H, Vardiman JW, eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press, 2001

Staging

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Staging
Ann Arbor Staging Classification for Hodgkin and Non-Hodgkin Lymphomas
Stage Description
I Involvement of a single lymph node region (I) or involvement of a single extralymphatic organ or site (IE)
II Involvement of 2 or more lymph node regions or lymphatic structures on the same side of the diaphragm alone (II) or with involvement of limited, contiguous extralymphatic organ or tissue (IIE)
III Involvement of lymph node regions on both sides of the diaphragm (III), which may include the spleen (IIIS), or limited, contiguous extralymphatic organ or site (IIIE), or both (IIIES)
IV Diffuse or disseminated foci of involvement of one or more extralymphatic organs or tissues with or without associated lymphatic involvement
Abbreviations
A Asymptomatic
B Unexplained persistent or recurrent fever with temperature higher than 38°C (100.4°F) or recurrent drenching night sweats within 1 month or unexplained loss of >10% body weight within 6 months
E Limited direct extension into extralymphatic organ from adjacent lymph node

Carbone PP et ...

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