Treatment Guideline Chart

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.

Hodgkin's%20lymphoma Management

Follow Up

Tests After Completion of Initial Therapy

  • Restaging via PET-CT scan should be done after completion of chemotherapy, based on the Deauville criteria
    • Favorable, unfavorable and aggressive classic Hodgkin lymphoma (CHL) restaging should be based on the Deauville criteria
    • Restaging of nodular lymphocyte-predominant Hodgkin 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 and visually above adjacent background activity
    5 Uptake markedly higher than the liver and/or new lesions
    X New areas of uptake unlikely to be related to lymphoma
  • Biopsy and PET-CT scan may be requested for patients with Deauville 4-5 score after completion of therapy
  • CT scan with contrast of the neck, chest, abdomen, and pelvis may be requested at 6, 12 and 24 months after completion of therapy or 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)
    • Fasting glucose
    • Breast examination with mammography and magnetic resonance imaging (MRI) (8-10 years post-therapy or at age 40 years, whichever comes 1st) are advised for women previously irradiated at the chest or axillary area
    • Colonoscopy every 10 years for patients >50 years old

Timing of Follow-up

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