What is Hodgkin lymphoma?

Hodgkin lymphoma (HL) is distinctively either mononucleated or multinucleated. Hodgkin cells have a mononucleate form and Reed-Sternberg cells have a multinucleate form. Occurring most frequently in young adults (15-30 years old), these two cells types are interspersed with non-neoplastic inflammatory cells. HL is a rare one-of-a-kind monoclonal lymphoid neoplasm malignancy with high recovery rates.

Thus, Hodgkin's lymphoma is an uncommon type of cancer resulting from the proliferation of abnormal cells developed from a B lymphocyte, identified as Reed Sternberg cells. In fact, the tumor cells, unlike other cancers, are generally few in number, and their environment is very polymorphic and inflammatory. Additionally, HL results in enlarged lymph nodes that evolves slowly over several months.

Without doubt, in the past several decades, development is diagnosis and treatment of Hodgkin's lymphoma have improved the chances of full recovery for people suffering from this disease. Certainly, HL prognosis is steadily improving.

Hodgkin lymphoma types:

The two categories of Hodgkin cancer have been distinguished by clinical and biological studies:

• The classical Hodgkin lymphoma: 95% of Hodgkin lymphoma patients suffer from this disease type and it's further divided into 4 subtypes:
  • Lymphocyte-rich (LRHL): describes localized lymphadenopathy without pain.
  • Nodular sclerosis (NSHL): primarily affects young adults and manifests during early disease stages.
  • Lymphocyte-depleted (LDHL): Mostly targets the elderly, where extra-nodal involvement and HIV infection exists.
  • Mixed cellularity (MCHL): affecting both children and elderly, it typically presents at an advanced stage.
• The nodular lymphocyte-predominant Hodgkin lymphoma (NLP-HL): an extremely rare type that affects lymphocytes that appear like popcorn. As a matter of fact, it appears at an early stage and tends to need less meticulous treatments.

What causes Hodgkin lymphoma:

Above all, Hodgkin lymphoma has an unclear etiology. Nevertheless, Epstein-Barr virus (EBV) infection, autoimmune disorders and immunosuppression all increase your risk of Hodgkin lymphoma. Furthermore, Hodgkin lymphoma can occur because of family history. Fact is, EBV is more prevalent in MCHL and LDHL where immunity loss is the culprit.

The risks of developing HL increase with immunosuppression. Whether the immunosuppression is resulting from a organ or hematopoietic cell transplant, HIV infection or immunosuppressive therapy, it all poses a threat. Unfortunately, AIDS patients face a very poor prognosis as they get the disease at an advanced stage and develop unusual lymph node locations.

Finally, the findings from studies suggest that genes and environment interact in the development of Hodgkin lymphoma in the patient's siblings of the same sex.

Symptoms of Hodgkin lymphoma:

HL most often manifests itself by cervical lymphadenopathy. Indeed, this cervical manifestation is generally visible, palpable and painless. Moreover, sometimes it comes in association with general signs such as:

• Fever
• Night sweats
• Weight loss
• Fatigue "Asthenia"
• Itchy skin "Pruritus"
• Pain in lymph nodes when drinking alcohol
• Chest pain and breath shortness if enlargement of the mediastinum node occurs

Besides, it rarely causes symptomatic compression of neighboring organs responsible for respiratory discomfort or superior vena cava syndrome.

Hodgkin lymphoma diagnosis:

Physical testing: This involves finding out about any symptoms in relation with HL. Also, a physical exam which includes examining the neck, groin, underarms, spleen and liver swelling.

Biopsy: A biopsy of a lymph node or a suspicious organ is required to confirm a diagnosis of HL. However, the lack of architecture and little density of malignant cells cause fine-needle aspirations and core-needle biopsies to show non-specific results. To illustrate further, analyzing the lymphoma cells helps determine the specific type of cancer and its appropriate treatment depending on cell surface markers.

Blood testing: Such tests involve complete blood count (CBC) test, erythrocyte sedimentation, complete metabolic panel (CMP), HIV, Hepatitis B and C viruses.

Scanning or imaging tests: x-ray of the chest, CT scans of the chest, abdomen and pelvis, and PET/CT scans can all be used to assess HL staging. In recent years, PET/CT imaging is widely used for assessing the progress of HL and most other lymphomas.

Treatment:

Treatment options vary from patient to patient and are influenced by your overall health, your preference, and the type and stage of cancer.

Chemotherapy: it is an effective way to eliminate malignant cells in your body. Whether taken orally or intravenously, the drug can reach all body parts and kill the cancer cells. Moreover, this treatment can be administered with radiation therapy,

Radiation therapy: This line of treatment doesn't help the majority of patients. Despite the successful treatment at the beginning, 10% will be resistant to this treatment. Also, 30% will suffer all over again after a complete successful initial radiation.

Stem cell transplant: patients who have relapsed or are refractory to initial therapy will typically undergo high-dose chemotherapy in association with stem cell transplant.

References:

-Aggarwal P, Limaiem F. Reed Sternberg Cells. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542333/

-Kaseb H, Babiker HM. Hodgkin Lymphoma. [Updated 2021 Jun 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499969/

-PDQ Pediatric Treatment Editorial Board. Childhood Hodgkin Lymphoma Treatment (PDQ®): Health Professional Version. 2022 Apr 8. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK65726/

-Mauch PM, Weiss L, Armitage JO. Treatment of Stage I-II Hodgkin's Disease. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003. Available from: https://www.ncbi.nlm.nih.gov/books/NBK13682/

-Image credits: https://www.freepik.com/vectors/lymph