Hodgkin Lymphoma Workup

  • Author: Scott K Dessain, MD, PhD; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: May 24, 2012
 

Approach Considerations

The foundation for determining the ideal Hodgkin lymphoma treatment is accurate staging, which requires a comprehensive evaluation of possible sites of disease by imaging and sampling (biopsy), as well as an assessment of prognostic factors.

Next

Imaging

For imaging studies, anteroposterior and lateral chest radiography is performed to assess the bulk of the mediastinal mass, which has prognostic importance. On computed tomography (CT) scans of the chest, abdomen, and pelvis, possible abnormal findings include enlarged lymph nodes, hepatomegaly and/or splenomegaly (with or without focal parenchymal abnormalities), lung nodules or infiltrates, and pleural effusions. Positron emission tomography (PET) scanning is now considered essential to the initial staging of Hodgkin lymphoma, and this is often performed in conjunction with CT scanning.[10] A mediastinal mass, representing mediastinal lymphadenopathy, is a very common finding in classic Hodgkin lymphoma, although it is uncommon in nodular lymphocyte-predominant Hodgkin disease (NLPHD).

Previous
Next

Biopsy

A histologic diagnosis of Hodgkin lymphoma is always required. An excisional lymph node biopsy is recommended because the lymph node architecture is important for histologic classification. When a patient presents with neck lymphadenopathy and risk factors for a head and neck cancer, a fine-needle aspiration (FNA) is usually advised as the initial diagnostic step, followed by excisional biopsy if squamous cell histology is excluded.

Bone marrow biopsies are indicated in some cases. Bone marrow involvement is more common in patients who are elderly or have advanced-stage disease, systemic symptoms, or a high-risk histology. Because Hodgkin lymphoma in the bone marrow is often patchy, bilateral bone marrow biopsies are advised to improve yield. A bone marrow biopsy can be omitted in patients with stage I Hodgkin lymphoma and some patients with stage II disease without hematologic abnormalities.

Sampling of a pleural effusion by thoracentesis and examination of the cells obtained may be useful in the evaluation of Hodgkin lymphoma. The pleural fluid may be an exudate or transudate, or it may be chylous.

CNS evaluation by lumbar puncture and magnetic resonance imaging (MRI) should be performed if symptoms or signs of CNS involvement are present. CNS involvement with Hodgkin lymphoma is exceedingly rare, but it has been reported.

Previous
Next

Blood Studies

Hematological (complete blood cell [CBC] count) and blood chemistry studies may reveal nonspecific findings in patients with Hodgkin lymphoma that may be associated with disease extent. Several of these findings have been used as prognostic factors.

CBC count studies for anemia (low red blood cell count), lymphopenia (low white blood cell count), excess neutrophils (neutrophilia), or eosinophils (eosinophilia) should be performed. Hodgkin lymphoma–associated anemia is most commonly the anemia of chronic disease. However, it may result from bone marrow involvement by tumor or from the presence of an autoantibody (as indicated by a positive warm-agglutinin on a Coombs test). Platelet counts may be increased or decreased.

The erythrocyte sedimentation rate (ESR)—a general marker of inflammation—may be elevated in Hodgkin lymphoma. An elevated ESR has been associated with worse prognosis. However, the ESR is a nonspecific test that should not be used for Hodgkin lymphoma screening.

Lactate dehydrogenase (LDH) may be increased. LDH may correlate with the bulk of disease.

Serum creatinine may be elevated, in the rare cases of nephrotic syndrome associated with Hodgkin lymphoma. Alkaline phosphatase (ALP) may be increased due to the presence of liver or bone involvement. Other uncommon laboratory findings include hypercalcemia, hypernatremia, and hypoglycemia (due to the presence of insulin autoantibodies).

An HIV test is important in the workup of Hodgkin lymphoma, because antiviral therapies can improve disease outcomes in HIV-positive patients.[11]

Serum levels of cytokines (interleukin [IL]-6, IL-10) and soluble CD25 (IL-2 receptor) correlate with tumor burden, systemic symptoms, and prognosis, but these studies are generally obtained only in special situations or in the context of a clinical trial.

Previous
Next

Staging Laparotomy

A staging laparotomy is a surgical procedure that includes splenectomy with biopsies of the liver and lymph nodes in the para-aortic, mesenteric, portal, and splenic hilar regions. At present, a staging laparotomy procedure is very rarely indicated, because even early-stage Hodgkin lymphoma is most often treated with combination chemotherapy.

The procedure can be helpful in rare cases in which radiation therapy is under consideration as the sole treatment of early-stage Hodgkin lymphoma.

Previous
Next

Staging

Clinical staging involves assessment of disease extent by clinical examination, history, and imaging techniques. When staging laparotomies are used as part of staging, the disease extent is designated as pathologic staging.[12]

The Ann Arbor classification (1971) is used most often for Hodgkin lymphoma. It classifies cases into the following 4 stages, principally on the basis of lymph node involvement:

  • Stage I - a single lymph node area or single extranodal site
  • Stage II - 2 or more lymph node areas on the same side of the diaphragm
  • Stage III - denotes lymph node areas on both sides of the diaphragm
  • Stage IV - disseminated or multiple involvement of the extranodal organs

Involvement of the liver or the bone marrow is considered stage IV disease. For staging classifications, the spleen is considered to be a lymph node area. Involvement of the spleen is denoted with the S suffix (ie, IIBS).

A or B designations denote the absence or presence of B symptoms. A "B" designation includes the presence of 1 or more of the following:

  • Fever (temperature >38°C)
  • Drenching night sweats
  • Unexplained loss of more than 10% of body weight within the preceding 6 months

An "A" designation is the absence of the above.

An "X" designation is sometimes used to indicate the presence of bulky disease.

Approximately one third of new patients have splenic involvement based on laparotomy data. However, this depends on the histologic subtype. Two thirds of patients with the mixed cellularity subtype have splenic involvement, compared with only one third of patients with the lymphocyte-depleted or nodular sclerosis histology. When liver or bone marrow involvement is present, the spleen is likely to be involved.

Spread of Hodgkin lymphoma takes place via the lymphatics, hematogenous routes, and direct extension. Contiguous involvement of extranodal sites (eg, involvement of the lung parenchyma due to direct extension of large mediastinal lymphadenopathy) is not considered stage IV disease. Rather, it is designated with the E suffix (ie, IIBE).

Unfavorable factors in limited-stage Hodgkin lymphoma

Many factors that can be assessed at the time of diagnosis can help to determine whether a patient's Hodgkin lymphoma has a high or low risk of proving resistant to therapy. Such an estimate is important for treatment planning. In addition, it can help identify patients who would potentially benefit from participating in clinical trials that seek to either minimize therapy in low-risk patients or intensify therapy in high-risk patients.

In patients with stage I or II disease, the following factors are considered unfavorable and, if present, will increase the intensity of the recommended initial therapy:

  • Bulky disease
  • An ESR of 50 mm/h or higher, if the patient is otherwise asymptomatic
  • More than 3 sites of disease involvement
  • The presence of B symptoms
  • The presence of extranodal disease

For this purpose, bulky disease is defined as a mediastinal mass greater than one third of the intrathoracic diameter on a chest radiograph or greater than 35% of the thoracic diameter at vertebral level T5-6. Hodgkin lymphoma also qualifies as bulky disease if it is greater than 10 cm in diameter on a CT scan.

Unfavorable factors in advanced Hodgkin lymphoma

The International Prognostics Factors Project (IPFP) was a survey of the characteristics at diagnosis and outcomes of 5,141 patients with Hodgkin lymphoma with either advanced disease, defined as either stage III or IV disease, or earlier-stage disease with systemic symptoms or bulky features. The following characteristics were determined to each contribute independently to an increased relative risk for Hodgkin lymphoma progression despite therapy:

  • Serum albumin less than 4 g/dL
  • Hemoglobin less than 10.5 g/dL
  • Male sex
  • Stage IV disease
  • Age 45 years or older
  • White blood cell (WBC) count greater than 15,000/μL
  • Lymphocyte count less than 600/μL or less than 8% of the total WBC count

The International Prognostic Score (IPS) is considered to be the number of features that are present at diagnosis for Hodgkin lymphoma.[13] The IPS correlates with the rate of freedom from disease progression and overall survival. Patients with 0-1 of these factors would be predicted to have a 90% overall survival. In contrast, patients with 4 or more of these factors may have an overall survival rate of only 59%.

One limitation of this scoring method is its inability to clearly identify the highest-risk subgroup of patients with Hodgkin lymphoma—that is, those who may benefit from up-front high-dose therapy. Analysis of cytokines and other serum markers may help to identify these patients in the future.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Scott K Dessain, MD, PhD  Associate Professor, Lankenau Institute for Medical Research

Disclosure: Nothing to disclose.

Coauthor(s)

Bradley W Lash, MD  Fellow in Hematology/Oncology, The Lankenau Medical Center

Bradley W Lash, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Clinical Oncology, and American Society of Hematology

Disclosure: Nothing to disclose.

James L Spears, MD  Consulting Staff, Bux-Mont Hematology Oncology Medical Associates

James L Spears, MD is a member of the following medical societies: American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Athanassios Argiris, MD  Professor, Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine

Athanassios Argiris, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Koyamangalath Krishnan, MD, FRCP, FACP  Paul Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, James H Quillen College of Medicine at East Tennessee State University

Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, and Royal College of Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Virginia Kaklamani, MD, and Christine Wasilewski, MD, MPH,to the development and writing of the source article.

References

  1. Jaffe ES, Harris NL, Stein H, Vardiman JW, eds. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2001.

  2. Thomas RK, Re D, Wolf J, Diehl V. Part I: Hodgkin's lymphoma--molecular biology of Hodgkin and Reed-Sternberg cells. Lancet Oncol. Jan 2004;5(1):11-8. [Medline].

  3. Re D, Küppers R, Diehl V. Molecular pathogenesis of Hodgkin's lymphoma. J Clin Oncol. Sep 10 2005;23(26):6379-86. [Medline].

  4. Hjalgrim H, Smedby KE, Rostgaard K, et al. Infectious mononucleosis, childhood social environment, and risk of Hodgkin lymphoma. Cancer Res. Mar 1 2007;67(5):2382-8. [Medline].

  5. Chang ET, Canchola AJ, Cockburn M, et al. Adulthood residential ultraviolet radiation, sun sensitivity, dietary vitamin D, and risk of lymphoid malignancies in the California Teachers Study. Blood. Aug 11 2011;118(6):1591-9. [Medline]. [Full Text].

  6. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2006. CA Cancer J Clin. Mar-Apr 2006;56(2):106-30. [Medline]. [Full Text].

  7. Keegan TH, Clarke CA, Chang ET, Shema SJ, Glaser SL. Disparities in survival after Hodgkin lymphoma: a population-based study. Cancer Causes Control. Jun 26 2009;[Medline].

  8. Ng AK, Mauch PM. Late complications of therapy of Hodgkin's disease: prevention and management. Curr Hematol Rep. Jan 2004;3(1):27-33. [Medline].

  9. Ménard F, Besson C, Rincé P, et al. Hodgkin lymphoma-associated hemophagocytic syndrome: a disorder strongly correlated with Epstein-Barr virus. Clin Infect Dis. Aug 15 2008;47(4):531-4. [Medline].

  10. Juweid ME, Stroobants S, Hoekstra OS, et al. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol. Feb 10 2007;25(5):571-8. [Medline]. [Full Text].

  11. Hentrich M, Maretta L, Chow KU, et al. Highly active antiretroviral therapy (HAART) improves survival in HIV-associated Hodgkin's disease: results of a multicenter study. Ann Oncol. Jun 2006;17(6):914-9. [Medline]. [Full Text].

  12. Mani H, Jaffe ES. Hodgkin lymphoma: an update on its biology with new insights into classification. Clin Lymphoma Myeloma. Jun 2009;9(3):206-16. [Medline].

  13. Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease. N Engl J Med. Nov 19 1998;339(21):1506-14. [Medline]. [Full Text].

  14. Evens AM, Helenowski I, Ramsdale E, et al. A retrospective multicenter analysis of elderly Hodgkin lymphoma: outcomes and prognostic factors in the modern era. Blood. Jan 19 2012;119(3):692-5. [Medline].

  15. Böll B, Bredenfeld H, Gorgen H, et al. Phase 2 study of PVAG (prednisone, vinblastine, doxorubicin, gemcitabine) in elderly patients with early unfavorable or advanced stage Hodgkin lymphoma. Blood. Dec 8 2011;118(24):6292-8. [Medline].

  16. Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Bello CM, Bierman PJ, et al. Hodgkin lymphoma. J Natl Compr Canc Netw. Sep 1 2011;9(9):1020-58. [Medline].

  17. Eichenauer DA, Engert A, Dreyling M. Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. Sep 2011;22 Suppl 6:vi55-8. [Medline].

  18. Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. Feb 10 2007;25(5):579-86. [Medline]. [Full Text].

  19. Fermé C, Eghbali H, Meerwaldt JH, et al. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med. Nov 8 2007;357(19):1916-27. [Medline]. [Full Text].

  20. Meyer RM, Gospodarowicz MK, Connors JM, et al. ABVD alone versus radiation-based therapy in limited-stage Hodgkin's lymphoma. N Engl J Med. Feb 2 2012;366(5):399-408. [Medline].

  21. Schmitz N, Pfistner B, Sextro M, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial. Lancet. Jun 15 2002;359(9323):2065-71. [Medline].

  22. Przepiorka D, van Besien K, Khouri I, et al. Carmustine, etoposide, cytarabine and melphalan as a preparative regimen for allogeneic transplantation for high-risk malignant lymphoma. Ann Oncol. May 1999;10(5):527-32. [Medline]. [Full Text].

  23. Advani R, Maeda L, Lavori P, et al. Impact of positive positron emission tomography on prediction of freedom from progression after Stanford V chemotherapy in Hodgkin's disease. J Clin Oncol. Sep 1 2007;25(25):3902-7. [Medline]. [Full Text].

  24. Gallamini A, Hutchings M, Rigacci L, et al. Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin's lymphoma: a report from a joint Italian-Danish study. J Clin Oncol. Aug 20 2007;25(24):3746-52. [Medline]. [Full Text].

  25. Levine JM, Weiner M, Kelly KM. Routine use of PET scans after completion of therapy in pediatric Hodgkin disease results in a high false positive rate. J Pediatr Hematol Oncol. Nov 2006;28(11):711-4. [Medline].

  26. Canellos GP, Anderson JR, Propert KJ, et al. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med. Nov 19 1992;327(21):1478-84. [Medline].

  27. Horning SJ, Hoppe RT, Breslin S, et al. Stanford V and radiotherapy for locally extensive and advanced Hodgkin's disease: mature results of a prospective clinical trial. J Clin Oncol. Feb 1 2002;20(3):630-7. [Medline]. [Full Text].

  28. Diehl V, Franklin J, Pfreundschuh M, et al. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med. Jun 12 2003;348(24):2386-95. [Medline]. [Full Text].

  29. [Best Evidence] Engert A, Diehl V, Franklin J, et al. Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin's lymphoma: 10 years of follow-up of the GHSG HD9 study. J Clin Oncol. Sep 20 2009;27(27):4548-54. [Medline].

  30. Viviani S, Zinzani PL, Rambaldi A, et al. ABVD versus BEACOPP for Hodgkin's lymphoma when high-dose salvage is planned. N Engl J Med. Jul 21 2011;365(3):203-12. [Medline].

  31. Bauer K, Skoetz N, Monsef I, Engert A, Brillant C. Comparison of chemotherapy including escalated BEACOPP versus chemotherapy including ABVD for patients with early unfavourable or advanced stage Hodgkin lymphoma. Cochrane Database Syst Rev. Aug 10 2011;CD007941. [Medline].

  32. Kasamon YL, Jacene HA, Gocke CD, Swinnen LJ, Gladstone DE, Perkins B. Phase 2 study of rituximab-ABVD in classical Hodgkin lymphoma. Blood. May 3 2012;119(18):4129-32. [Medline].

  33. Younes A, Oki Y, McLaughlin P, Copeland AR, Goy A, Pro B. Phase 2 study of rituximab plus ABVD in patients with newly diagnosed classical Hodgkin lymphoma. Blood. May 3 2012;119(18):4123-8. [Medline].

  34. Edwards-Bennett SM, Jacks LM, Moskowitz CH, et al. Stanford V program for locally extensive and advanced Hodgkin lymphoma: the Memorial Sloan-Kettering Cancer Center experience. Ann Oncol. Mar 2010;21(3):574-81. [Medline].

  35. Engert A, Franklin J, Eich HT, et al. Two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine plus extended-field radiotherapy is superior to radiotherapy alone in early favorable Hodgkin's lymphoma: final results of the GHSG HD7 trial. J Clin Oncol. Aug 10 2007;25(23):3495-502. [Medline]. [Full Text].

  36. Engert A, Plutschow A, Eich HT, et al. Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma. N Engl J Med. Aug 12 2010;363:640-652.

  37. Eich HT, Diehl V, Gorgen H, et al. Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD11 trial. J Clin Oncol. Sep 20 2010;28(27):4199-206. [Medline].

  38. Viviani S, Zinzani PL, Rambaldi A, et al. ABVD versus BEACOPP for Hodgkin's lymphoma when high-dose salvage is planned. N Engl J Med. Jul 21 2011;365(3):203-12. [Medline].

  39. Portlock CS. Nodular lymphocyte predominant Hodgkin's disease. Cancer Treat Res. 2006;131:353-62. [Medline].

  40. Schulz H, Rehwald U, Morschhauser F, et al. Rituximab in relapsed lymphocyte-predominant Hodgkin lymphoma: long-term results of a phase 2 trial by the German Hodgkin Lymphoma Study Group (GHSG). Blood. Jan 1 2008;111(1):109-11. [Medline]. [Full Text].

  41. Eichenauer DA, Fuchs M, Pluetschow A, et al. Phase 2 study of rituximab in newly diagnosed stage IA nodular lymphocyte-predominant Hodgkin lymphoma: a report from the German Hodgkin Study Group. Blood. Oct 20 2011;118(16):4363-5. [Medline].

  42. Savage KJ, Skinnider B, Al-Mansour M, Sehn LH, Gascoyne RD, Connors JM. Treating limited-stage nodular lymphocyte predominant Hodgkin lymphoma similarly to classical Hodgkin lymphoma with ABVD may improve outcome. Blood. Oct 27 2011;118(17):4585-90. [Medline].

  43. Lavoie JC, Connors JM, Phillips GL, et al. High-dose chemotherapy and autologous stem cell transplantation for primary refractory or relapsed Hodgkin lymphoma: long-term outcome in the first 100 patients treated in Vancouver. Blood. Aug 15 2005;106(4):1473-8. [Medline]. [Full Text].

  44. Gopal AK, Metcalfe TL, Gooley TA, et al. High-dose therapy and autologous stem cell transplantation for chemoresistant Hodgkin lymphoma: the Seattle experience. Cancer. Sep 15 2008;113(6):1344-50. [Medline].

  45. Anderlini P, Saliba R, Acholonu S, et al. Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: the updated M.D. Anderson Cancer Center experience. Haematologica. Feb 2008;93(2):257-64. [Medline]. [Full Text].

  46. Younes A, Bartlett NL, Leonard JP, Kennedy DA, Lynch CM, Sievers EL, et al. Brentuximab vedotin (SGN-35) for relapsed CD30-positive lymphomas. N Engl J Med. Nov 4 2010;363(19):1812-21. [Medline]. [Full Text].

  47. Chen R, Gopal AK, Smith SE, Ansell SM, Rosenblatt JD, Klasa R, et al. Results of a Pivotal Phase 2 Study of Brentuximab Vedotin (SGN-35) in Patients with Relapsed or Refractory Hodgkin Lymphoma. American Society of Hematology (ASH) 52nd Annual Meeting: Abstract 283, presented December 6, 2010. American Society of Hematology. Available at http://ash.confex.com/ash/2010/webprogram/Paper30260.html. Accessed August 22, 2011.

  48. Witzig TE, Tang H, Micallef IN, et al. Multi-institutional phase 2 study of the farnesyltransferase inhibitor tipifarnib (R115777) in patients with relapsed and refractory lymphomas. Blood. Nov 3 2011;118(18):4882-9. [Medline]. [Full Text].

  49. Ansell SM, Horwitz SM, Engert A, et al. Phase I/II study of an anti-CD30 monoclonal antibody (MDX-060) in Hodgkin's lymphoma and anaplastic large-cell lymphoma. J Clin Oncol. Jul 1 2007;25(19):2764-9. [Medline]. [Full Text].

  50. Bartlett NL, Younes A, Carabasi MH, et al. A phase 1 multidose study of SGN-30 immunotherapy in patients with refractory or recurrent CD30+ hematologic malignancies. Blood. Feb 15 2008;111(4):1848-54. [Medline].

  51. Takach S, Yang L, Ho J, et al. Monoclonal B cells detected in autologous PBSC grafts from patients with classical Hodgkin lymphoma: impact on relapse and survival following transplantation. Bone Marrow Transplant. May 2010;45(5):856-61. [Medline].

  52. Chen R, Gopal AK, Smith SE, et al. Results of a pivotal phase 2 study of brentuximab vedotin (SGN-35) in patients with relapsed or refractory Hodgkin lymphoma. Presented at: American Society of Hematology Annual Meeting; December 4-7, 2010; Orlando, Fla. Blood. 2010;116(21):Abstract 283.

  53. Aleman BM, van den Belt-Dusebout AW, De Bruin ML, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood. Mar 1 2007;109(5):1878-86. [Medline]. [Full Text].

  54. Wethal T, Lund MB, Edvardsen T, et al. Valvular dysfunction and left ventricular changes in Hodgkin's lymphoma survivors. A longitudinal study. Br J Cancer. Aug 18 2009;101(4):575-81. [Medline]. [Full Text].

  55. Heidenreich PA, Schnittger I, Strauss HW, et al. Screening for coronary artery disease after mediastinal irradiation for Hodgkin's disease. J Clin Oncol. Jan 1 2007;25(1):43-9. [Medline]. [Full Text].

  56. Milano MT, Li H, Constine LS, Travis LB. Survival after second primary lung cancer: a population-based study of 187 Hodgkin lymphoma patients. Cancer. Dec 15 2011;117(24):5538-47. [Medline].

  57. Swerdlow AJ, Higgins CD, Smith P, et al. Second Cancer Risk After Chemotherapy for Hodgkin's Lymphoma: A Collaborative British Cohort Study. J Clin Oncol. Nov 1 2011;29(31):4096-104. [Medline].

  58. Barbaro PM, Johnston K, Dalla-Pozza L, et al. Reduced incidence of second solid tumors in survivors of childhood Hodgkin's lymphoma treated without radiation therapy. Ann Oncol. Dec 2011;22(12):2569-74. [Medline].

  59. Behringer K, Breuer K, Reineke T, et al. Secondary amenorrhea after Hodgkin's lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen, and the use of oral contraceptives during therapy: a report from the German Hodgkin's Lymphoma Study Group. J Clin Oncol. Oct 20 2005;23(30):7555-64. [Medline].

  60. Sieniawski M, Reineke T, Josting A, et al. Assessment of male fertility in patients with Hodgkin's lymphoma treated in the German Hodgkin Study Group (GHSG) clinical trials. Ann Oncol. Oct 2008;19(10):1795-801. [Medline].

  61. Hodgson DC, Pintilie M, Gitterman L, et al. Fertility among female hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy. Hematol Oncol. Mar 2007;25(1):11-5. [Medline].

  62. Kornblith AB, Herndon JE 2nd, Zuckerman E, et al. Comparison of psychosocial adaptation of advanced stage Hodgkin's disease and acute leukemia survivors. Cancer and Leukemia Group B. Ann Oncol. Mar 1998;9(3):297-306. [Medline].

  63. Loge JH, Abrahamsen AF, Ekeberg, Kaasa S. Fatigue and psychiatric morbidity among Hodgkin's disease survivors. J Pain Symptom Manage. Feb 2000;19(2):91-9. [Medline].

  64. Canioni D, Deau-Fischer B, Taupin P, et al. Prognostic significance of new immunohistochemical markers in refractory classical Hodgkin lymphoma: a study of 59 cases. PLoS One. Jul 22 2009;4(7):e6341. [Medline]. [Full Text].

 
Previous
Next
 
Mixed cellularity Hodgkin lymphoma showing both mononucleate and binucleate Reed-Sternberg cells in a background of inflammatory cells (hematoxylin and eosin, original magnification X200).
A positron emission tomography (PET) scan obtained with fluorodeoxyglucose (FDG) that shows increased FDG uptake in a mediastinal lymph node.
A CT scan showing bulk disease.
Hodgkin Lymphoma
Hodgkin Lymphoma PET
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.