Hodgkin’s lymphoma

An estimated 8,490 new cases of Hodgkin’s lymphoma were diagnosed in the USA in 2010. Reed–Sternberg cells are the malignant cells in classical Hodgkin’s lymphoma (CD15+, CD30+, and CD45−). In nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL), these cells express B-cell markers (CD20+, CD79a+, and CD45+) and are CD15− and CD30−. Common presentation is an asymptomatic lymph node enlargement in supradiaphragmatic areas (neck, mediastinum). Approximately 70% will have stage I or II disease. For early-stage disease, the standard approach is a combined modality with short-course chemotherapy (ABVD: Adriamycin, bleomycin, vinblastine, dacarbazine), followed by moderate-dose radiation targeting involved lymph node region(s). When subdivided into favorable and unfavorable groups, 5-year disease-free survival rates of approximately 90–95% (favorable) and 85–90% (unfavorable) are expected, respectively. The majority of patients with NLPHL present at an early stage and have excellent prognoses with radiation alone. For advanced-stage disease, chemotherapy is the main modality, and the focus recently has been on intensifying chemotherapy to improve efficacy. When a complete response has been obtained with ABVD chemotherapy or its equivalent, there is no role for consolidation radiation therapy. Overall 5-year diseasefree survival is 60–85%. High-dose therapy with autologous stem cell transplant is the salvage therapy of choice for refractory patients or for those who relapse after a short initial remission from chemotherapy. Different types of radiation fields have been used in Hodgkin’s lymphoma and involved-field radiation therapy (IFRT) is the current standard. It covers involved lymph nodes before chemotherapy and the nodal region (wholly or partially) in which the involved lymph node(s) is/are located. The radiation doses used in combined-modality protocols are well within the tolerance of normal tissues in virtually all supradiaphragmatic areas.