Hodgkin Lymphoma

There are two main types of Hodgkin lymphoma:

Classical Hodgkin lymphoma: 95% of patients with Hodgkin lymphoma are diagnosed with classical Hodgkin lymphoma. It is also the most common type of Hodgkin lymphoma to affect children.

Classical Hodgkin lymphoma can be separated into four sub-categories:

• Nodular sclerosis Hodgkin lymphoma: This is the most common type of Hodgkin lymphoma in adolescents and young adults. Tumours are often very bulky; they most often begin in the lymph nodes in the neck, chest, or abdomen and may spread to the lungs.
• Mixed cellularity Hodgkin lymphoma: This type is more common in children aged 10 years or younger and shows the strongest link to the virus that causes mononucleosis called the Epstein-Barr virus. It usually begins in the lymph nodes in the abdomen or in the spleen.
• Lymphocyte rich Hodgkin lymphoma: This type of lymphoma is rare and may be hard to distinguish from lymphocyte predominant Hodgkin lymphoma. It usually begins in the lymph nodes of the neck, underarm, and groin, and sometimes involves the spleen and nodes in the chest.
• Lymphocyte depleted Hodgkin lymphoma: A very rare, aggressive type of lymphoma more common in adults. This type usually spreads through the body, involving lymph nodes as well as bones and bone marrow.

Lymphocyte-predominant Hodgkin lymphoma: Only affects 5% of patients. Lymphocyte-predominant Hodgkin lymphoma usually grows at a slower rate than classical Hodgkin lymphoma and normally requires less intensive treatment.

The risk of Hodgkin lymphoma is increased if you contract a disease that lowers your immune system. Other risk factors for Hodgkin lymphoma include the following:

• The Epstein – Barr virus: A virus that stays dormant in most people. However, it is the cause of infectious mononucleosis (also known as Glandular Fever).
• HIV: Being infected with the human immunodeficiency virus (HIV)
• Having certain inherited diseases of the immune system.
• Personal history of mononucleosis (mono).
• Being exposed to common infections in early childhood may decrease the risk of Hodgkin lymphoma because of the effect it has on the immune system.

The first sign of classical Hodgkin lymphoma is usually a painless swelling of one gland, or a group of lymph glands, which continues for some weeks or even months.

The first glands that are likely to be affected are in the neck or above the collarbone, most often only on one side. However, it’s important to remember that glands can also become swollen with common infection, causing a sore throat or a cold.

Patients with Lymphocyte-predominant Hodgkin lymphoma may have a single swollen gland or group of swollen glands in one area only, such as the neck or groin. The swollen gland often grows very slowly and may be present for many months before a biopsy and diagnosis happens.

If glands in the chest are affected, this can cause a cough or breathlessness, due to the pressure of the glands on the airways.

Sometimes, patients with Hodgkin lymphoma may suffer:

• A high temperature (fever)
• Night sweats
• Weight loss
• Or itchy skin.

The most common treatment for Hodgkin lymphoma is chemotherapy along with radiation.

Those with low-risk Hodgkin lymphoma often have up to six months of chemotherapy. For intermediate-risk disease, chemotherapy treatment usually lasts from four to six months and for high-risk disease about five to seven months.

Overall, 80% to 95% of Hodgkin lymphoma patients are cured of their disease, however, this rate depends on the stage of the lymphoma, the size of any tumours, how the patient tolerates the therapy and other factors including current health.

If a tumour is present, your doctors may suggest surgery, however, this is not very common.

Usually, they will remove a whole lymph node for the purpose of a biopsy to test whether or not Hodgkin Lymphoma is present. In some cases, doctors may remove a smaller sample from another tumour site.

If relapse occurs after treatment, the patient will then be treated with high doses of chemotherapy combined with a hematopoietic cell, or stem cell, transplant.

However, such high doses of chemotherapy can damage the bone marrow resulting in the marrow not being able to make new blood cells. Bone marrow or stem cells treatment will, therefore, be given through a vein. This is called an infusion.

Sometimes a patient’s stem cells will be extracted before chemotherapy and stored so they can be used for treatment afterwards. This is called an autologous stem cell transplant.

In rare cases, or if the Hodgkin lymphoma comes back after the transplant, doctors may perform an allogeneic stem cell transplant (stem cells which come from a donor whose cells closely match the patient’s cells). For either type of transplant, radiation is given before the transplant or after they recover from the transplant.

The treatment plan will be based on the type of lymphoma, the stage of the disease, how far it has spread and patient’s overall health.