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252 / Chapter 19 Hodgkin lymphoma

ated with an 8% reduction in the predicted 5 year
Table 19.3 Hodgkin lymphoma: International

Prognostic Index (Hansclever Index) for disease - free progression rate (Table 19.3 ). Overall,
advanced disease. approximately 85% of patients are cured.

Age > 45 years The l ate e ffects of Hodgkin
Male gender l ymphoma and i ts t reatment
Serum albumin < 40 g/dL Long - term follow - up of patients has revealed a con-
Haemoglobin level < 10.5 g/dL siderable burden of late disease following treatment.
Secondary cancers such as lung cancer and breast
Stage IV disease
cancer appear to be related to radiotherapy whereas
9
Leucocytosis (white cell count ≥ 15 × 10 /L) myelodysplasia or acute myeloid leukaemia are

9
Lymphopaenia ( < 0.6 × 10 /L or < 8% of the white more associated with the use of alkylating agents.

cell count) Non - Hodgkin lymphomas and other cancers also
occur with greater frequency than in controls. Non -
Prognosis malignant complications include sterility, intestinal
complications, coronary artery disease and other
The prognosis depends on age, stage and histology. cardiac or pulmonary complications of the medias-

The International Prognostic Score (Hansclever tinal radiation or chemotherapy. These features are

Index) is useful for patients with advanced disease. the main reason why less intensive treatment regi-
It includes seven factors and each of these is associ- mens are now being explored for this disease.
SUMMARY ■ Lymphomas are a group of diseases ■ Diagnosis is made by histological

sedimentation rate (ESR) or lactic

caused by malignant lymphocytes that
dehydrogenase (LDH).
accumulate in lymph nodes and cause

lymphadenopathy.
examination of an excised lymph node and

■ The major subdivision of lymphomas is

there are four subtypes of disease.

■ Staging of the disease is important for
into Hodgkin lymphoma and non - Hodgkin
lymphoma and this is based on the
presence of Reed – Sternberg cells in
History, examination, blood tests, CT and

Hodgkin lymphoma. determining treatment and prognosis.
PET scan are typically used.
■ Reed – Sternberg cells are neoplastic B cells ■ Treatment is with radiotherapy,

but most cells in the lymph node are chemotherapy or a combination of both.
reactive infl ammatory cells. The choice depends on the stage and

■ The usual clinical presentation is with grade of the disease.
painless asymmetrical lymphadenopathy ■ The response to treatment can be

– most commonly in the neck. monitored by CT and PET scans. Disease
■ Constitutional symptoms of fever, weight relapse can be treated with chemotherapy,

loss and sweating are prominent in sometimes with stem cell transplantation.

patients with widespread disease. ■ The prognosis is excellent and over 85% of

■ Blood tests may show anaemia, patients can expect to be cured. Late side

neutrophilia and raised erythrocyte effects of treatment are a concern.

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