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For further information, see CMDT Part 13-33: Hodgkin Lymphoma
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Essentials of Diagnosis
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Lymphadenopathy, often painless
Constitutional symptoms may or may not be present
Pathologic diagnosis by lymph node biopsy
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General Considerations
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Group of cancers characterized by lymph node biopsy showing Reed-Sternberg cells in an appropriately reactive cellular background
Malignant cell is a B lymphocyte
Divided into pathologic subtypes
Classic Hodgkin lymphoma (four types: nodular sclerosis, mixed cellularity, lymphocyte rich, and lymphocyte depleted)
Non-classic Hodgkin lymphoma (nodular lymphocyte predominant)
Tendency to arise within single lymph node areas and spread in orderly fashion to contiguous lymph nodes
Widespread hematogenous dissemination occurs only late in course
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Painless lymphadenopathy (mass), commonly in neck
Constitutional symptoms, eg, fever, weight loss, or night sweats, or generalized pruritus
Pain in involved lymph node after alcohol ingestion is an unusual symptom
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Differential Diagnosis
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Diagnostic Procedures
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Serum chemistries, whole body PET/CT scan, and bone marrow biopsy
Staging nomenclature (Ann Arbor)
Stage I, one lymph node region involved
Stage II, involvement of two or more lymph node regions on one side of diaphragm
Stage III, lymph node regions involved on both sides of diaphragm
Stage IV, disseminated disease with extranodal involvement
In addition, designated as stage A if there is a lack of constitutional symptoms and stage B if there is a 10% weight loss over 6 months, fever, or night sweats ("B symptoms")
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For stage I and II disease: combination of short course chemotherapy with involved-node radiotherapy
ABVD: doxorubicin, bleomycin, vinblastine, dacarbazine
Stanford V: doxorubicin, vinblastine, bleomycin, vincristine, nitrogen mustard, prednisone, etoposide
For stage III or IV disease: full course of ABVD (no radiotherapy) or Stanford V chemotherapy (with radiotherapy to masses > 5 cm)
Chemotherapy is the mainstay of treatment and ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) remains the standard first-line regimen due to its manageable toxicity
The substitution of the antibody-drug conjugate brentuximab vedotin for bleomycin (AAVD) has demonstrated
The more intense regimen, escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone), is
Stage I and II disease: combination of short-course chemotherapy with involved-node radiotherapy or full course of chemotherapy alone ...