Hodgkin Lymphoma Board and Resident Review Points

Hodgkin Lymphoma

The most common type is the classic HL which is characterized by Reed-Sternberg cells (giant owl's eye cells), especially those EBV related. HIV is in particular more prone to EBV and hence HL. B symptoms are common which include fever, night sweats and weight loss. Most commonly start with a neck or mediastinal LN. Although rare but look for pain exaggerated by alcohol ingestion. Lymphopenia and eosinophilia are common findings. Choose LN excision for diagnosis. Chose CT/PET of the chest/abdomen/pelvis for staging. If anemia or B symptoms are present then look forbone biopsy as well.

Staging of Hodgkin's Lymphoma:

Stage I one region involved either a LN or an organ

Stage II two or more LNs on the same side of the diaphragm

Stage III LNs on both sides of the diaphragm

Stage IV Wide extra-lymphatic spread

Combination ABVD chemotherapy is the standard treatment with some variation or additional radiation depending on the stage.

ABVD includes:

A: doxorubicin hydrochloride (Adriamycin)

B: bleomycin sulfate

V: vinblastine sulfate

D: dacarbazine

Refer the patient for autologous stem cell transplantation if chemo not successful. Consider sperm cryopreservation for men desiring fertility.

Things to consider with this topic are the side effects of treatment. Radiation therapy increases risk of cancers, hypothyroidism and cardiac/pericardiac conditions. Doxorubicin can cause cardiomyopathy. Bleomycin can cause pulmonary toxicity. Look for acute leukemia and MDS (myelodysplastic syndrome) with chemo.

A good reading for patient support is this award-winning book by neurobiologist: Living with Lymphoma.

           This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your local emergency services or your primary care provider. Please refer to your doctor for medical advice.