Hodgkin’s Disease
A distinctive form of lymphoma, Hodgkin’s disease has served as a model for treatment trials, as great strides have been made in the therapy of this disease such that today the vast majority of patients are cured. Staging of Hodgkin’s lymphoma is not based on the local extent of disease but on its distribution and symptomatology. It is usually not possible to determine the primary tumor site. When the patient presents, the disease is often widely disseminated. Important for staging is the evaluation of many organs and groups of lymph nodes for tumor involvement. The disease is often associated with unusual immunologic abnormalities, and a diversity of symptoms, including: fever, chills, night sweats, and unintentional weight loss. Staging is considered critical for patient management.
Hodgkin’s Disease Treatment Summaries
Early staged Hodgkin’s disease
Early stage Hodgkin’s lymphoma remains a highly curable disease. Stage I and II Hodgkin’s are lymphomas that are confined to one or two adjacent lymph node regions. PET scanning is a new imaging modality that permits increased accuracy in determining early stage disease and monitoring for relapse. The standard of care remains combined modality therapy with a short course of chemotherapy followed by consolidative involved field radiotherapy. This approach maximizes the effectiveness of both modalities and minimizes potential toxicities. Cure rates approach 95% for early stage Hodgkin’s disease.
References:
- Bonnadonna G et al. ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: Long-term results. J Clin Oncol. 2004; 22: 2835-2841.
- Guay C, et al. Prognostic value of PET using 18F-FDG in Hodgkin's disease for posttreatment evaluation. J Nucl Med. 2003; 44: 1225-1231.
- Lavely WC et al. FDG-PET in the follow-up management of patients with newly diagnosed Hodgkin and non-Hodgkin lymphoma after first-line chemotherapy. Int J Radiat Oncol Biol Phys 2003; 57: 307-315.
- Yahalom J. Don't throw out the baby with the bathwater: On optimizing cure and reducing toxicity in Hodgkin lymphoma. J Clin Oncol. 2006; 24: 544-548.
Advanced Hodgkin’s disease
Advanced Hodgkin’s lymphoma is categorized as Stage III or IV disease. This includes disease involving lymph node regions on both sides of the diaphragm as well as bone marrow involvement. PET Scanning is a new treatment modality that permits more accurate staging. Bone marrow biopsy continues to be an important staging tool. It remains a highly treatable and potentially curable disease even in a more advanced stage. The International Prognostic Score (IPS) includes 7 variables that affect prognosis. These include age, sex, and several laboratory parameters. Patients with 0 or 1 risk factors still achieve 80% 5 year disease free survival rates with standard chemotherapy, while patients with 4 or more adverse variables have disease free survival expectations in the 45 to 60% range. The standard treatment for advanced Hodgkin’s disease is 6 to 8 months of systemic chemotherapy. Salvage chemotherapy and stem cell transplant are considerations for those patients with relapsed disease or those who do not achieve remission with standard therapy.
References
- Duggan DB, et al. Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin's disease: report of an Intergroup trial. J Clin Oncol. 2003;21:607-614.
- Guay C, et al. Prognostic value of PET using 18F-FDG in Hodgkin's disease for posttreatment evaluation. J Nucl Med. 2003; 44: 1225-1231.
- Lavely WC et al. FDG-PET in the follow-up management of patients with newly diagnosed Hodgkin and non-Hodgkin lymphoma after first-line chemotherapy. Int J Radiat Oncol Biol Phys 2003; 57: 307-315.
