hodgkin's%20lymphoma
HODGKIN'S LYMPHOMA

Hodgkin's lymphoma is a malignancy that arises from germinal center B cell.

Histologically, there is a presence of multinucleated giant cells in a mixed inflammatory background.

It is also known as Hodgkin's disease, Hodgkin lymphoma or Hodgkin disease.

It commonly affects individuals ages 15-30 years old and those 55 years old and above.

The key morphologic characteristics include presence of Reed-Sternberg cells and lymphocyte-predominant cells.

Follow Up

Tests After Completion of Initial Therapy

  • Restaging via positron emission tomography-computed tomography (PET-CT) scan should be done after completion of chemotherapy, based on the Deauville criteria
    • Favorable, unfavorable, and aggressive classic Hodgkin's lymphoma (CHL) restaging should be based on the Deauville criteria
    • Restaging of nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) patients is recommended after completion of initial therapy
  • PET 5-Point Scale (Deauville Criteria)

  • Score PET-CT scan result
    1 No uptake
    2 Uptake ≤ mediastinum
    3 Uptake > mediastinum but ≤ liver
    4 Uptake moderately higher than the liver
    5 Uptake markedly higher than the liver &/or new lesions
    X New areas of uptake unlikely to be related to lymphoma
  • Biopsy & positron emission tomography-computed tomography (PET-CT) scan may be requested for patients with Deauville 4-5 score after completion of therapy
  • Computed tomography (CT) scan may be requested once during the 1st 12 months after completion of therapy, then as clinically indicated
  • Other imaging studies of initially involved sites (eg ultrasonography, chest radiography) may be repeated
  • The following should be tested annually 5 years after therapy completion:
    • Blood pressure
    • Complete blood count (CBC), platelets, chemistry profile
    • Thyroid Stimulating hormone (TSH) (for patients with radiotherapy to the neck)
    • Lipid profile (2x/year)
    • Annual breast examination with mammography & magnetic resonance imaging (MRI) is advised for women previously irradiated at the chest or axillary area
    • Colonoscopy every 10 yr for patients >50 years old

Timing of Follow-up

  • Yearly follow-up should be advised for the first 5 years after treatment
  • Patients should undergo complete physical examination & history taking every 2-4 months for 1-2 years, then every 3-6 months for the next 3-5 years
  • Complete blood count (CBC), platelet count, erythrocyte sedimentation rate (ESR), & chemistry profile should be obtained as clinically indicated
  • A low-dose computed tomography (CT) scan of chest may be requested after 5 years for patients at increased risk for lung cancer & have undergone treatment with non-alkylating chemotherapeutic agents, no previous radiation therapy, & no other risk factors
  • Thorough physical examination & psychologic evaluation is recommended every 4-6 month for the first 5 years
  • Physical exams & blood tests [complete blood count (CBC), erythrocyte sedimentation rate (ESR), blood chemistry] should be done for nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) patients every 3-6 months for 1-2 years, then every 6-12 months for the next 3 years, then annually
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