What are the diagnostic criteria for Hodgkin's (Hodgkin) lymphoma?

From the Guidelines

Hodgkin's lymphoma diagnosis requires a comprehensive approach, including a tissue biopsy showing Reed-Sternberg cells, physical examination, blood tests, and imaging studies, with the definitive diagnosis coming from an excisional lymph node biopsy, as recommended by the NCCN guidelines 1. The diagnostic process for Hodgkin's lymphoma typically begins with a physical examination to check for enlarged lymph nodes, followed by blood tests to assess overall health and rule out other conditions.

• Imaging studies such as CT scans, PET scans, or MRIs help determine the extent of disease.
• The NCCN guidelines recommend an excisional lymph node biopsy, where an entire lymph node is removed for examination, as the gold standard for diagnosis 1.
• Once diagnosed, staging procedures determine how far the cancer has spread, using the Ann Arbor staging system (stages I-IV).
• Additional tests may include bone marrow biopsy, immunophenotyping, and genetic testing to classify the specific subtype of Hodgkin's lymphoma.
• Early diagnosis is crucial for effective treatment, which typically involves chemotherapy regimens like ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) or radiation therapy, depending on the stage and subtype, with cure rates exceeding 80% for many patients, especially when diagnosed in early stages 1.
• The prognosis for Hodgkin's lymphoma is generally favorable, with significant progress made in management and treatment options, leading to improved 5-year survival rates 1.

From the Research

Diagnosis of Hodgkin's Lymphoma

• Hodgkin's lymphoma is a rare B-cell malignant neoplasm, accounting for approximately 10-15% of all lymphomas 2, 3, 4.
• The disease is traditionally classified as classical Hodgkin lymphoma or nodular lymphocyte-predominant Hodgkin lymphoma, with subgroups including nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich Hodgkin lymphoma 3, 4.
• Diagnosis is typically made through an open lymph node biopsy, with staging incorporating symptoms and the extent of the disease as shown on positron emission tomography/computed tomography (PET/CT) 2, 3, 4.
• Prognostic models, such as those identifying patients at high or low risk for recurrence, are used to optimize therapy 3, 4.

Symptoms and Presentation

• Patients with Hodgkin's lymphoma often present with supradiaphragmatic lymphadenopathy and systemic B symptoms, such as fever, unexplained weight loss, and night sweats 3, 5, 6.
• The disease can occur at any age, but is most commonly diagnosed in young adults, with a second peak in patients over 60 years old 6.

Treatment Options

• First-line treatment typically consists of stage-adapted chemotherapy and/or radiotherapy, with cure rates of approximately 80% 6.
• Combined-modality therapies, including abbreviated courses of chemotherapy followed by involved-field radiation treatment, are commonly used for early-stage disease 3, 4.
• Advanced-stage disease is often treated with a longer course of chemotherapy, with or without radiation therapy 3, 4.
• Novel approaches, such as antibody-drug conjugates and immunomodulatory drugs, have shown promise in clinical trials and are being incorporated into earlier treatment lines 5, 6, 4.
• High-dose chemotherapy followed by an autologous stem cell transplant is the standard of care for most patients who relapse following initial therapy 3, 4.