Hodgkin's Disease

  • Incidence 2/100,000

  • Associated with EBV

  • can be related to HIV/AIDS

Clinical Features

  • Peak age is in the 20s

  • Painless lymphadenopathy

    • commonly involves mediastinum

  • splenomegaly

  • (rarely) bone marrow / extra-nodal involvement

  • systemic symptoms

    • fever

    • sweat

    • weight loss

    • pruritus

    • alcohol-induced pain

Diagnosis

  • need histology - preferably of a whole node

  • pathognomic feature in Reed-Sternberg cell with 'owl-eye' inclusions

Staging

Ann Arbor classification

  • Stage I - 1 nodal group involved

  • Stage II - 2+ nodal areas, same side of diaphragm

  • Stage III - nodal groups both sides of diaphragm, restricted to lymph nodes or spleen

  • Stage IV - Extra-nodal spread

  • +A (absence) / +B (presence) of

    • fever >38°C,

    • Weight Loss >10% over 6 months

    • night sweats

  • +E extra-nodal involvement

Grading

  • Lymphocyte predominant

    • reactive immune system present

  • nodular sclerosing

    • common

  • mixed cellularity

  • lymphocyte depleted

    • loss of immune function

Treatment

  • Early stage (1A-2A)

  • Advanced (1B,2B, 3, 4)

    • chemotherapy

      • ABVD

    • raqdiotherapy to bulky / painful lesions

  • Relapsed cases

    • alternative chemotherapt regime

    • raiodtherapy to bulky disease

    • autologous stem cell transplantation

Side Effects

  • Risk of malignancies

    • myelodeysplasia

    • AML

      • 4 years after treatment

      • esp. if alkylating agent + radiotherapy

  • Sterility

  • Intestinal complications

  • myocardial infarction

  • cardiac / respiratory complications

Prognosis

Cure rates

  • Early stage - 95%

  • B / IV - 70%

Depends on

  • age

  • sex - male worse than female

  • grade

Late deaths from secondary malignancies and relapse

 

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