Hodgkin Lymphoma

Year 2024, , 28 - 36, 30.03.2024

Nergiz Erkut

https://doi.org/10.59518/farabimedj.1325315

Abstract

Hodgkin lymphoma (HL) is a rare malignant neoplasm of the lymphatic system. It accounts for approximately 10% of all lymphomas. Although it is frequently observed in young people, it is observed less frequently in the elderly. HL is a malignancy that originates from the germinal center B lymphocytes and is characterized by a marked increase in inflammatory cells in the tumoral microenvironment. There are two types, classical HL and nodular lymphocyte-predominant HL (NLPHL), which have different clinical and pathological features. Classical HL accounts for 90-95%, and NLPHL 5-10% of cases. Approximately 80% of patients are cured with chemotherapy and/or radiotherapy. This review will focus on the epidemiology, etiology, pathobiology, clinic, diagnosis and treatment of HL.

Keywords

Clinic, Diagnosis, Hodgkin lymphoma, Treatment

Hodgkin Lenfoma

Abstract

Hodgkin lenfoma (HL), lenfatik sistemin nadir görülen malign bir neoplazisidir. Tüm lenfomaların yaklaşık %10’unu oluşturmaktadır. Sıklıkla gençlerde izlenmekle birlikte, daha az oranda yaşlılarda da gözlenmektedir. HL, germinal merkez B lenfositlerden kaynaklanan ve tümöral mikroçevrede belirgin inflamatuvar hücre artışı ile karakterize bir malignensidir. Klinik ve patolojik özellikleri farklı olan klasik HL ve nodüler lenfosit-predominant HL (NLPHL) olmak üzere iki tipi mevcuttur. Klasik HL vakaların %90-%95’ini, NLPHL ise %5-10’unu oluşturmaktadır. Kemoterapi ve/veya radyoterapi ile hastaların yaklaşık %80’inde kür sağlanmaktadır. Bu derlemede HL’nin epidemiyoloji, etiyoloji, patobiyoloji, klinik, tanı ve tedavisi üzerinde durulacaktır.

Keywords

Hodgkin lenfoma, Klinik, Tanı, Tedavi

Supporting Institution

Hayır

References

• Swerdlow SH, Campo E, Harris NL, et al. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th eds. International Agency for Research on Cancer. 2017:423-442.
• Sasse S, Bröckelmann PJ, Goergen H, et al. Long-Term Follow-Up of Contemporary Treatment in Early-Stage Hodgkin Lymphoma: Updated Analyses of the German Hodgkin Study Group HD7, HD8, HD10, and HD11 Trials. J Clin Oncol. 2017;35(18):1999-2007. doi:10.1200/JCO.2016.70.9410
• National Cancer Institute Surveillance Epidemiology and End Results Program. Cancer stat facts: Hodgkin lymphoma. SEER https://seer.cancer.gov/statfacts/ html/hodg.html. 2019.
• Storm HH, Klint A, Tryggvadóttir L, et al. Trends in the survival of patients diagnosed with malignant neoplasms of lymphoid, haematopoietic, and related tissue in the Nordic countries 1964-2003 followed up to the end of 2006. Acta Oncol. 2010;49(5):694-712. doi:10.3109/02841861003631495
• Kaushansky K, Lichtman MA, Prchal JT, Levi M, Burns LJ, Linch DC. Williams Hematology. McGraw Hill. 10th eds. Spinner MA, Mou E, Advani RH. Hodgkin lymphoma. 2021; p: 1683-1711.
• Momotow J, Borchmann S, Eichenauer DA, Engert A, Sasse S. Hodgkin Lymphoma-Review on Pathogenesis, Diagnosis, Current and Future Treatment Approaches for Adult Patients. J Clin Med. 2021;10(5):1125. Published 2021 Mar 8. doi:10.3390/jcm10051125
• Connors JM, Cozen W, Steidl C, et al. Hodgkin lymphoma [published correction appears in Nat Rev Dis Primers. 2021 Oct 20;7(1):79]. Nat Rev Dis Primers. 2020;6(1):61. Published 2020 Jul 23. doi:10.1038/s41572-020-0189-6
• Brune V, Tiacci E, Pfeil I, et al. Origin and pathogenesis of nodular lymphocyte-predominant Hodgkin lymphoma as revealed by global gene expression analysis. J Exp Med. 2008;205(10):2251-2268. doi:10.1084/jem.20080809
• Brice P, de Kerviler E, Friedberg JW. Classical Hodgkin lymphoma. Lancet. 2021;398(10310):1518-1527. doi:10.1016/S0140-6736(20)32207-8
• Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M. Report of the Committee on Hodgkin's Disease Staging Classification. Cancer Res. 1971;31(11):1860-1861.
• Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32(27):3059-3068. doi:10.1200/JCO.2013.54.8800
• Hoppe RT, Advani RH, Ai WZ, et al. NCCN Guidelines® Insights: Hodgkin Lymphoma, Version 2.2022. J Natl Compr Canc Netw. 2022;20(4):322-334. doi:10.6004/jnccn.2022.0021
• Moccia AA, Donaldson J, Chhanabhai M, et al. International Prognostic Score in advanced-stage Hodgkin's lymphoma: altered utility in the modern era. J Clin Oncol. 2012;30(27):3383-3388. doi:10.1200/JCO.2011.41.0910
• Engert A, Plütschow A, Eich HT, et al. Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma. N Engl J Med. 2010;363(7):640-652. doi:10.1056/NEJMoa1000067
• André MPE, Girinsky T, Federico M, et al. Early Positron Emission Tomography Response-Adapted Treatment in Stage I and II Hodgkin Lymphoma: Final Results of the Randomized EORTC/LYSA/FIL H10 Trial. J Clin Oncol. 2017;35(16):1786-1794. doi:10.1200/JCO.2016.68.6394
• Fuchs M, Goergen H, Kobe C, et al. Positron Emission Tomography-Guided Treatment in Early-Stage Favorable Hodgkin Lymphoma: Final Results of the International, Randomized Phase III HD16 Trial by the German Hodgkin Study Group. J Clin Oncol. 2019;37(31):2835-2845. doi:10.1200/JCO.19.00964
• 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. 2011;365(3):203-212. doi:10.1056/NEJMoa1100340
• Fermé C, Thomas J, Brice P, et al. ABVD or BEACOPPbaseline along with involved-field radiotherapy in early-stage Hodgkin Lymphoma with risk factors: Results of the European Organisation for Research and Treatment of Cancer (EORTC)-Groupe d'Étude des Lymphomes de l'Adulte (GELA) H9-U intergroup randomised trial. Eur J Cancer. 2017;81:45-55. doi:10.1016/j.ejca.2017.05.005
• Meyer RM. Limited-Stage Hodgkin Lymphoma: Clarifying Uncertainty. J Clin Oncol. 2017;35(16):1760-1763. doi:10.1200/JCO.2017.72.2611
• von Tresckow B, Plütschow A, Fuchs M, et al. Dose-intensification in early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD14 trial. J Clin Oncol. 2012;30(9):907-913. doi:10.1200/JCO.2011.38.5807
• Gillessen S, Plütschow A, Fuchs M, et al. Dose-intensification in early unfavorable Hodgkin lymphoma: Long-term follow up of the German Hodgkin Study Group (GHSG) HD14 trial. Blood. 2019;134:129.
• Borchmann P, Plütschow A, Kobe C, et al. PET-guided omission of radiotherapy in early-stage unfavourable Hodgkin lymphoma (GHSG HD17): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2021;22(2):223-234. doi:10.1016/S1470-2045(20)30601-X
• Gallamini A, Rossi A, Patti C, et al. Consolidation Radiotherapy Could Be Safely Omitted in Advanced Hodgkin Lymphoma With Large Nodal Mass in Complete Metabolic Response After ABVD: Final Analysis of the Randomized GITIL/FIL HD0607 Trial [published correction appears in J Clin Oncol. 2021 Jan 1;39(1):96]. J Clin Oncol. 2020;38(33):3905-3913. doi:10.1200/JCO.20.00935
• Skoetz N, Trelle S, Rancea M, et al. Effect of initial treatment strategy on survival of patients with advanced-stage Hodgkin's lymphoma: a systematic review and network meta-analysis. Lancet Oncol. 2013;14(10):943-952. doi:10.1016/S1470-2045(13)70341-3
• von Tresckow B, Kreissl S, Goergen H, et al. Intensive treatment strategies in advanced-stage Hodgkin's lymphoma (HD9 and HD12): analysis of long-term survival in two randomised trials. Lancet Haematol. 2018;5(10):e462-e473. doi:10.1016/S2352-3026(18)30140-6
• Stephens DM, Li H, Schöder H, et al. Five-year follow-up of SWOG S0816: limitations and values of a PET-adapted approach with stage III/IV Hodgkin lymphoma. Blood. 2019;134(15):1238-1246. doi:10.1182/blood.2019000719
• Johnson P, Federico M, Kirkwood A, et al. Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin's Lymphoma. N Engl J Med. 2016;374(25):2419-2429. doi:10.1056/NEJMoa1510093
• Casasnovas RO, Bouabdallah R, Brice P, et al. PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study. Lancet Oncol. 2019;20(2):202-215. doi:10.1016/S1470-2045(18)30784-8
• Connors JM, Jurczak W, Straus DJ, et al. Brentuximab Vedotin with Chemotherapy for Stage III or IV Hodgkin's Lymphoma [published correction appears in N Engl J Med. 2018 Mar 1;378(9):878]. N Engl J Med. 2018;378(4):331-344. doi:10.1056/NEJMoa1708984
• Straus DJ, Długosz-Danecka M, Alekseev S, et al. Brentuximab vedotin with chemotherapy for stage III/IV classical Hodgkin lymphoma: 3-year update of the ECHELON-1 study. Blood. 2020;135(10):735-742. doi:10.1182/blood.2019003127
• Rancea M, Monsef I, von Tresckow B, Engert A, Skoetz N. High-dose chemotherapy followed by autologous stem cell transplantation for patients with relapsed/refractory Hodgkin lymphoma. Cochrane Database Syst Rev. 2013;(6):CD009411. Published 2013 Jun 20. doi:10.1002/14651858.CD009411.pub2
• 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. 2002;359(9323):2065-2071. doi:10.1016/S0140-6736(02)08938-9
• Bröckelmann PJ, Müller H, Casasnovas O, et al. Risk factors and a prognostic score for survival after autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma. Ann Oncol. 2017;28(6):1352-1358. doi:10.1093/annonc/mdx072
• Garcia-Sanz R, Sureda A, de la Cruz F, et al. Brentuximab vedotin and ESHAP is highly effective as second-line therapy for Hodgkin lymphoma patients (long-term results of a trial by the Spanish GELTAMO Group). Ann Oncol. 2019;30(4):612-620. doi:10.1093/annonc/mdz009
• Hagenbeek A, Zijlstra JM, Plattel WJ, et al. Combining brentuximab vedotin with DHAP as salvage treatment in relapsed/refractory Hodgkin lymphoma: The phase II HOVON/LLPC transplant BRaVE study. Blood. 2018;132:2923. Doi:10.1182/blood-2018-99-112235
• Moskowitz CH, Nademanee A, Masszi T, et al. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantation in patients with Hodgkin's lymphoma at risk of relapse or progression (AETHERA): a randomised, double-blind, placebo-controlled, phase 3 trial [published correction appears in Lancet. 2015 Aug 8;386(9993):532] [published correction appears in Lancet. 2015 Aug 8;386(9993):532]. Lancet. 2015;385(9980):1853-1862. doi:10.1016/S0140-6736(15)60165-9
• Younes A, Gopal AK, Smith SE, et al. Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma. J Clin Oncol. 2012;30(18):2183-2189. doi:10.1200/JCO.2011.38.0410
• Armand P, Engert A, Younes A, et al. Nivolumab for Relapsed/Refractory Classic Hodgkin Lymphoma After Failure of Autologous Hematopoietic Cell Transplantation: Extended Follow-Up of the Multicohort Single-Arm Phase II CheckMate 205 Trial [published correction appears in J Clin Oncol. 2018 Sep 10;36(26):2748]. J Clin Oncol. 2018;36(14):1428-1439. doi:10.1200/JCO.2017.76.0793
• Chen R, Zinzani PL, Fanale MA, et al. Phase II Study of the Efficacy and Safety of Pembrolizumab for Relapsed/Refractory Classic Hodgkin Lymphoma. J Clin Oncol. 2017;35(19):2125-2132. doi:10.1200/JCO.2016.72.1316
• Eichenauer DA, Plütschow A, Fuchs M, et al. Long-Term Course of Patients With Stage IA Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the German Hodgkin Study Group. J Clin Oncol. 2015;33(26):2857-2862. doi:10.1200/JCO.2014.60.4363
• Chen RC, Chin MS, Ng AK, et al. Early-stage, lymphocyte-predominant Hodgkin's lymphoma: patient outcomes from a large, single-institution series with long follow-up. J Clin Oncol. 2010;28(1):136-141. doi:10.1200/JCO.2009.24.0945
• Eichenauer DA, Kreissl S, Bühnen I, et al. PET-2-guided escalated BEACOPP for advanced nodular lymphocyte-predominant Hodgkin lymphoma: a subgroup analysis of the randomized German Hodgkin Study Group HD18 study. Ann Oncol. 2021;32(6):807-810. doi:10.1016/j.annonc.2021.02.018
• Fanale MA, Cheah CY, Rich A, et al. Encouraging activity for R-CHOP in advanced stage nodular lymphocyte-predominant Hodgkin lymphoma. Blood. 2017;130(4):472-477. doi:10.1182/blood-2017-02-766121
• Prusila REI, Haapasaari KM, Marin K, et al. R-Bendamustine in the treatment of nodular lymphocyte-predominant Hodgkin lymphoma. Acta Oncol. 2018;57(9):1265-1267. doi:10.1080/0284186X.2018.1450522
• Xing KH, Connors JM, Lai A, et al. Advanced-stage nodular lymphocyte predominant Hodgkin lymphoma compared with classical Hodgkin lymphoma: a matched pair outcome analysis. Blood. 2014;123(23):3567-3573. doi:10.1182/blood-2013-12-541078
• Eichenauer DA, Plütschow A, Schröder L, et al. Relapsed and refractory nodular lymphocyte-predominant Hodgkin lymphoma: an analysis from the German Hodgkin Study Group. Blood. 2018;132(14):1519-1525. doi:10.1182/blood-2018-02-836437
• Eichenauer DA, Goergen H, Plütschow A, et al. Ofatumumab in relapsed nodular lymphocyte-predominant Hodgkin lymphoma: results of a phase II study from the German Hodgkin study group. Leukemia. 2016;30(6):1425-1427. doi:10.1038/leu.2015.321