Classical Hodgkin Lymphoma (cHL)
Characteristics
Hodgkin lymphoma (HL) is a blood cancer that affects a type of white blood cells called B-lymphocytes. In normal circumstances, these B-lymphocytes produce antibodies that target viruses, bacteria, cancer cells, and other foreign intruders. Classical HL (cHL) is the most common form of HL accounting for 90-95% of all the cases. The cancerous lymphocytes in cHL patients are called Reed-Sternberg cells and have a particular appearance under the microscope.
cHL can develop anywhere in the lymphatic system, but most commonly becomes apparent in the lymph nodes of the neck. cHL can develop at any age, but mainly affects people between 20 and 40 years of age and people above the age of 75. In addition to this, cHL is slightly more common in men than in women. In 2021, about 340 patients were diagnosed with cHL in Belgium.
In most patients, the cause of cHL is unknown. However, the risk for cHL is increased in people with a medical condition that weakens the immune system, in people who take immunosuppressing medication and in people who have been infected with the Epstein-Barr virus. In addition, the risk for cHL is also higher when you have a first-degree relative (i.e., parent, sibling, or child) who has this condition.
Symptoms
The most common symptom of cHL is a swelling of lymph nodes. These swollen lymph nodes can develop in any area of the body, but most commonly occur in the neck, armpit, or groin. In most cases, these swollen lymph nodes are painless. For some people, however, these lumps do ache, especially after drinking alcohol.
Other common symptoms of cHL include heavy sweating (especially at night), the development of fever without an obvious cause, (severe) itching and unexplained weight loss over a short period of time. In cHL patients with bone marrow involvement, a disturbed blood cell production may lead to shortness of breath and fatigue, an increased risk of infections and a tendency to bleed or bruise easily.
Depending on the location of the enlarged glands, patients may also experience other symptoms. For example, if lymph nodes in the abdomen are affected, patients may suffer from abdominal pain or indigestion.
Diagnostic tests
The diagnostic process for cHL starts with a physical examination, during which the doctor palpates lymph nodes and other areas of the body to check for swelling. The doctor will also assess the medical history of the patient to better understand the general health status and any potential risk factors. If a cHL is suspected, a lymph node biopsy is performed to make a final diagnosis. This is a simple procedure during which all, or part of a lymph node is removed from the body and sent to the laboratory for a microscopic evaluation. If this analysis reveals the presence of Reed-Sternberg cells, additional tests can be performed to assess how far the cancer has spread. This includes blood tests and imaging tests to look for signs of cHL in other areas of your body (X-ray, CT, PET, MRI, ultrasound). In some patients a bone marrow biopsy may also be performed.
Treatments
cHL is a relatively aggressive cancer and can quickly spread throughout the body. However, the treatment of cHL is usually very successful and the majority of patients can be cured. The type of treatment that is used depends on the disease stage, the overall health of the patient and his/her preference.
The main treatment modality for patients with cHL consists of chemotherapy (ABVD), either alone or followed by radiotherapy. Of note, for some (early-stage) patients, radiotherapy may be the only treatment that is required.
For patients who do not respond to their first line therapy (refractory), or when the disease comes back (relapse), a stem cell transplantation can be considered. For patients with relapsed/refractory disease who are unable to undergo a stem cell transplantation, an antibody-drug conjugate (brentuximab vedotin) or an immune checkpoint inhibitor (nivolumab, pembrolizumab) can be used.
Want to submit input to improve quality content on this blood disorder?