Hodgkin lymphoma

Histologic subtypes:

- Nodular sclerosing

- Mixed cellularity

- Lymphocyte predominance- Lymphocyte depleted

new category:

- Lymphocyte rich

Recommended Procedures for Staging of Hodgkin’s Patients

History and examination Identification of B symptoms

Recommended Procedures for Staging of Hodgkin’s Patients

History and examination Identification of B symptoms

Radiologic procedures Plain chest x-rays Computed tomograpy of thorax Computed tomograpy of abdomen and pelvis

Recommended Procedures for Staging of Hodgkin’s Patients

History and examination Identification of B symptoms Radiologic procedures Plain chest x-rays Computed tomograpy of thorax Computed tomograpy of abdomen and pelvis

Hematologic procedures Full blood count with differential count Determination of erythrocyte sedimentation rate Bilateral bone marrow aspiration and biopsy

Recommended Procedures for Staging of Hodgkin’s Patients

History and examination Identification of B symptoms Radiologic procedures Plain chest x-rays Computed tomograpy of thorax Computed tomograpy of abdomen and pelvis Hematologic procedures Full blood count with differential count Determination of erythrocyte sedimentation rate Bilateral bone marrow aspiration and biopsy

Biochemical procedures Liver function tests Serum albumin, lactate dehydrogenase, and calcium measurements

Recommended Procedures for Staging of Hodgkin’s Patients

History and examination Identification of B symptoms Radiologic procedures Plain chest x-rays Computed tomograpy of thorax Computed tomograpy of abdomen and pelvis Hematologic procedures Full blood count with differential count Determination of erythrocyte sedimentation rate Bilateral bone marrow aspiration and biopsy Biochemical procedures Liver function tests Serum albumin, lactate dehydrogenase, and calcium measurements

Procedures for use under special circumstances Ultrasound scanning Magnetic resonance imaging P E TGallium scanning

Ann Arbor Staging Classification for Hodgkin’s Disease

Stage I Involvement of a single lymph-node region (I) or a single extralymphatic organ or site (IE)

Ann Arbor Staging Classification for Hodgkin’s Disease

Stage I Involvement of a single lymph-node region (I) or a single extralymphatic organ or site (IE)

Stage II Involvement of two or more lymph-node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site (IIE)

Ann Arbor Staging Classification for Hodgkin’s Disease

Stage I Involvement of a single lymph-node region (I) or a single extralymphatic organ or site (IE) Stage II Involvement of two or more lymph-node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site (IIE)

Stage III Involvement of lymph-node regions on both sides of the diaphragm (III) or localized involvement of an extra-lymphatic organ or site (III E), spleen (IIIS), or both (IIISE)

Ann Arbor Staging Classification for Hodgkin’s Disease

Stage I Involvement of a single lymph-node region (I) or a single extralymphatic organ or site (IE) Stage II Involvement of two or more lymph-node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site (IIE) Stage III Involvement of lymph-node regions on both sides of the diaphragm (III) or localized involvement of an extra-lymphatic organ or site (III E), spleen (IIIS), or both (IIISE)

Stage IV Diffuse or disseminated involvement of one or more extralymphatic organs, with or without associated lymph-node involvement; the organ(s) involved should be identified by a symbol: (P) pulmonary, (O) osseous, or (H) hepatic.

Ann Arbor Staging Classification for Hodgkin’s Disease

Stage I Involvement of a single lymph-node region (I) or a single extralymphatic organ or site (IE) Stage II Involvement of two or more lymph-node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site (IIE) Stage III Involvement of lymph-node regions on both sides of the diaphragm (III) or localized involvement of an extra-lymphatic organ or site (III E), spleen (IIIS), or both (IIISE) Stage IV Diffuse or disseminated involvement of one or more extralymphatic organs, with or without associated lymph-node involvement; the organ(s) involved should be identified by a symbol: (P) pulmonary, (O) osseous, or (H) hepatic.

In addition,

(A) indicates an asymptomatic patient;

(B) indicates the presence of fever, night sweats, or weight loss > 10% of body weight.

Adapted from Hellman S, Jaffe ES, DeVita VT: Hodgkin’s disease, in DeVita VT Jr, Hellman S, Rosenberg SA (eds): Cancer: Principles and Practice of Oncology, p 1704. Philadelphia, JB Lippincott, 1989

Radiotherapy

Chemiotherapy

A B M T

Hodgkin lymphoma

Radiotherapy:

Involved field radiotherapy (IFRT):

35 to 44 Gy

150 – 200 cGy per daily

(5 days per week)

Radiotherapy

Chemiotherapy

A B M T

Hodgkin lymphomaTreatment:

stage IA, IB, IIA:

4xABVD (IFRT)

IIB, IIIA, IIIB, IVA, IVB:

6-8xABVD (BEACOPP) (+ IFRT)

Radiotherapy

Chemiotherapy

A B M T