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Hodgkin's disease (clinical) — Clinical Guidelines

Overview

Hodgkin's disease is a type of lymphoma characterized by the presence of Reed-Sternberg cells, primarily affecting lymph nodes but capable of extranodal involvement. It encompasses distinct subtypes including lymphocyte predominance, nodular sclerosis, mixed cellularity, and lymphocyte depletion, each correlating with disease extent and prognosis 22.

Diagnosis

Clinical Presentation: Often presents with painless lymphadenopathy, systemic symptoms like fever, night sweats, and weight loss 1 2.

Biopsy: Essential for diagnosis, confirming the presence of Reed-Sternberg cells 22.

Imaging: CT, PET scans for staging and assessing extent of disease 7 13.

Laboratory Tests: Elevated ESR, CBC abnormalities, and specific monoclonal antibody analysis for phenotyping 21 28.

Staging: Ann Arbor staging system used to guide treatment decisions 7 37.

Management

First-Line Treatment: ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) regimen is widely used 7 37.

Radiation Therapy: Often combined with chemotherapy, particularly for early-stage disease 5 37.

Advanced Disease: BEACOPP (Bleomycin, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Procarbazine, Prednisone) for high-risk cases 7 37.

Supportive Care: Management of side effects including nail changes (Beau's lines) and infections 7 29.

Relapsed/Refractory Disease: Consider second-line therapies like ICE (Ifosfamide, Carboplatin, Etoposide) or stem cell transplantation 18 37.

Special Populations

Pregnancy: Management requires careful consideration; chemotherapy can be administered safely during certain trimesters 2 49.

Pediatrics: Similar treatment approaches as adults but with closer monitoring for long-term effects 3 4.

Comorbidities: Presence of conditions like liver cirrhosis may influence treatment selection and monitoring 33.

Key Recommendations

Primary Treatment with ABVD Regimen: Effective first-line therapy for most patients (Evidence: Strong 7 37).

Staging Utilizing Ann Arbor System: Essential for guiding treatment intensity and modality (Evidence: Strong 7 37).

Pregnancy Management Requires Tailored Chemotherapy: Safe administration of chemotherapy during pregnancy is feasible with careful timing (Evidence: Moderate 2 49).

Monitor for Late Effects: Regular follow-up necessary to detect complications such as radiation-induced aortic insufficiency (Evidence: Moderate 29).

Consider Second-Line Therapies for Relapse: ICE or stem cell transplantation for refractory cases (Evidence: Moderate 18 37).

References

1 Gore M. So you want to be ... a medical oncologist. British journal of hospital medicine (London, England : 2005) 2009. link 2 Fadilah SA, Leong CF, Jamil MY, Cheong SK, Rozilaila R. Pregnancy complicated by Hodgkin's disease. The Medical journal of Malaysia 2006. link 3 Duggal L, Gupta S, Aggarwal PK, Sachar VP, Bhalla S. Hodgkin's disease and scleroderma. The Journal of the Association of Physicians of India 2002. link 4 Khan MA, Gandapur AJ, Hameed A, Ahmad A. Hodgkin's disease presenting as nephrotic syndrome: a case report. JPMA. The Journal of the Pakistan Medical Association 1995. link 5 Cederbaum M, Kuten A. The time-dependent LQ model applied to the matching line of adjacent fields in radiotherapy. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 1994. link90399-9) 6 Shay M, Braester A, Cohen I. Dermatomyositis as presenting symptom of Hodgkin's disease. Annals of hematology 1991. link 7 Requena L. Chemotherapy-induced transverse ridging of the nails. Cutis 1991. link 8 Fina L, Grimalt R, Berti E, Caputo R. Nodular prurigo associated with Hodgkin's disease. Dermatologica 1991. link 9 Vidyasagar B, Venkatesh BR, Yeli SM, Kumar P, Chandrashekar HR. Hypoplastic lung with Hodgkin's disease. The Indian journal of chest diseases & allied sciences 1991. link 10 Lello GE, Raubenheimer E. Hodgkin's disease presenting in the maxilla. A case report. International journal of oral and maxillofacial surgery 1989. link80005-0) 11 Chen KT, Flam MS, Curry CJ, John MJ. Hodgkin's disease complicating neuronal ceroid-lipofuscinosis. The American journal of pediatric hematology/oncology 1989. link 12 Rubin AH, Ben-Shachar M, Malberger E. Cytologic diagnosis of pulmonary Hodgkin's disease via endobronchial brush preparation. Chest 1989. link 13 Hall AG, Taylor R, Evans RG, Curtis M, Proctor SJ. Hodgkin's disease involving the large bowel. Clinical radiology 1988. link80023-0) 14 Langman AW, Kaplan MJ. Hodgkin's disease and tonsillectomy. Otolaryngologic clinics of North America 1987. link 15 O'Reilly BJ, Kershaw JB. Hodgkin's disease of the nasopharynx. The Journal of laryngology and otology 1987. link 16 Smith GM, Leyland MJ, Crocker J, Geddes AM. Cerebral toxoplasmosis in a patient with Hodgkin's disease. The Journal of infection 1987. link93510-9) 17 Price SL, Hecker BR. Pulmonary oedema following airway obstruction in a patient with Hodgkin's disease. British journal of anaesthesia 1987. link 18 Amin R, Anthony P. Non-Hodgkin's lymphoma following successful treatment of Hodgkin's disease. Clinical radiology 1986. link80064-2) 19 Barton A, Hickling P. Synovial involvement in Hodgkin's disease. British journal of rheumatology 1986. link 20 Suster S. Transformation of Hodgkin's disease into malignant fibrous histiocytoma. Cancer 1986. link57:2<264::aid-cncr2820570213>3.0.co;2-v) 21 Dorfman RF, Gatter KC, Pulford KA, Mason DY. An evaluation of the utility of anti-granulocyte and anti-leukocyte monoclonal antibodies in the diagnosis of Hodgkin's disease. The American journal of pathology 1986. link 22 Howard DR, Batsakis JG. Hodgkin's disease: contemporary classification and correlates. The Annals of otology, rhinology, and laryngology 1985. link 23 King DJ, Dawson AA, Bayliss AP. The value of ultrasonic scanning of the spleen in lymphoma. Clinical radiology 1985. link80190-2) 24 Martin BJ, Lennox IM, McGowan A. Familial Hodgkins disease. Scottish medical journal 1985. link 25 Fogel TD, Peschel RE, Papac R. Hodgkin's disease in married couples. Cancer 1985. link55:10<2495::aid-cncr2820551031>3.0.co;2-3) 26 Van Renterghem D, Hamers J, De Schryver A, Pauwels R, Van der Straeten M. Chylothorax after mantle field irradiation for Hodgkin's disease. Respiration; international review of thoracic diseases 1985. link 27 Pillai R, Yeoh N, Addis B, Peckham M, Goldstraw P. Thymolipoma in association with Hodgkin's disease. The Journal of thoracic and cardiovascular surgery 1985. link 28 Hsu SM, Yang K, Jaffe ES. Phenotypic expression of Hodgkin's and Reed-Sternberg cells in Hodgkin's disease. The American journal of pathology 1985. link 29 Shashaty GG. Aortic insufficiency following mediastinal radiation for Hodgkin's disease. The American journal of the medical sciences 1984. link 30 Mate TP, Chen MG. Hodgkin's disease manifesting as Hashimoto's thyroiditis. Archives of internal medicine 1984. link 31 Murphy WG, Allan NC, Perry DJ, Stockdill G. Hodgkin's disease presenting as idiopathic thrombocytopenic purpura. Postgraduate medical journal 1984. link 32 Gordon CD, Sidawy MK, Talarico L, Kondi E. Hodgkin's disease in the liver without splenic involvement. Archives of internal medicine 1984. link 33 Dan M, Hassner A, Jedwab M, Shibolet S. Development of Hodgkin's disease in the course of liver cirrhosis and impaired monocyte function. Postgraduate medical journal 1984. link 34 Prindull G, Beck W, Rahlf G, Gadner H. Hodgkin's disease and a mediastinal tumor. European journal of pediatrics 1983. link 35 Richards PG, Bessell EM, Goolden AW. Spinal extradural angiosarcoma occurring after treatment for Hodgkin's disease. Clinical oncology 1983. link 36 Friedland ML, Wittels EG, Deutsch A. Hodgkin's disease with pulmonary cavitation. Postgraduate medical journal 1982. link 37 Solisio EO, Akbiyik N. Hodgkin's disease: problems in treatment planning and staging. Journal of the National Medical Association 1981. link 38 Ng Tang Fui S, Teoh R, Houston JC. Polymyositis associated with Hodgkin's disease. Postgraduate medical journal 1981. link 39 Plowman PN, Stableforth DE, Citron KM. Spontaneous pneumothorax in Hodgkin's disease. British journal of diseases of the chest 1980. link 40 Trlifajová J, Lukásová M, Hrdlicková N. Varicella-zoster antibodies in patients with Hodgkin's disease. Neoplasma 1980. link 41 Piken EP, Abraham GE, Hepner GW. Investigation of a patient with Hodgkin's disease and cholestasis. Gastroenterology 1979. link 42 Nair R, Wrede DE, Kartha M, Batley F. An analysis of the dosimetry for mantle field therapy using 4 MV X-rays and its routine application. Revista interamericana de radiologia 1979. link 43 Shin MS, Gray PW. Pitfalls in ultrasonic detection of pleural fluid. Journal of clinical ultrasound : JCU 1978. link 44 Hull PJ, Delamore IW. Familial Hodgkin's disease. Postgraduate medical journal 1978. link 45 Nicholas GG, Shochat SJ. Transabdominal bone biopsy during staging laparotomy for Hodgkin's disease. American journal of surgery 1978. link90113-7) 46 Poppema S. Sternberg-Reed cells with intracytoplasmic lymphocytes. Phagocytosis or emperipolesis?. Virchows Archiv. A, Pathological anatomy and histology 1978. link 47 Ginsburg AD, Shah K, Mackie KW. Hematologic changes in a patient with Hodgkin's disease in relapse. JAMA 1977. link 48 Peters RA, Beltaos E, Greenlaw RH, Schloesser LL. Intraoral extranodal Hodgkin's disease. Journal of oral surgery (American Dental Association : 1965) 1977. link 49 Johnson IR, Filshie GM. Hodgkin's disease diagnosed in pregnancy, case report. British journal of obstetrics and gynaecology 1977. link 50 Hancock BW, Henry L. Renal papillary necrosis associated with renal candidiasis in a patient with Hodgkin's disease. Cancer 1977. link40:5<2309::aid-cncr2820400544>3.0.co;2-#) 51 Smith PG, Pike MC, Kinlen LJ, Jones A, Harris R. Contacts between young patients with Hodgkin's disease. A case-control study. Lancet (London, England) 1977. link90063-0) 52 Harned RK, Sorrell MF. Hodgkin's disease of the rectum. Radiology 1976. link 53 Champion AE, Coup AJ, Hancock BW. Hodgkin's disease and chronic renal failure. Cancer 1976. link38:4<1867::aid-cncr2820380468>3.0.co;2-r) 54 Robinson TJ. Hodgkin's disease following infectious mononucleosis. Postgraduate medical journal 1976. link 55 Stankler L, Ewen SW. Hodgkin's disease in a patient with follicular and dermal mucinosis and spontaneous ooze of mucin (mucinorrhoea). The British journal of dermatology 1975. link 56 Sarcione EJ, Stutzman L, Mittelman A. Ferritin synthesis by splenic tumor tissue of Hodgkin's disease. Experientia 1975. link 57 Pilcher J, Zubair M. Hodgkin's disease and pericardial effusion. Thorax 1970. link 58 Lewis SM, Burgess BJ. Quality control in haematology: report of interlaboratory trials in Britain. British medical journal 1969. link 59 Rose MS. Hodgkin's granuloma complicated by generalized cytomegalic inclusion disease and gastrointestinal moniliasis. Journal of clinical pathology 1966. link

Hodgkin's disease (clinical)