B Symptoms in Hodgkin Lymphoma
B symptoms in Hodgkin lymphoma are defined as unexplained fever >38°C, drenching night sweats, or weight loss >10% of body weight within 6 months of diagnosis. 1
Definition and Clinical Significance
B symptoms are part of the Ann Arbor staging system for Hodgkin lymphoma (HL) and have important prognostic implications:
Each stage of HL is subdivided into categories A and B:
- "A" indicates no systemic symptoms are present
- "B" is assigned when any of the following are present:
- Unexplained fever >38°C (>100.4°F)
- Drenching night sweats
- Weight loss >10% of body weight within 6 months of diagnosis 1
These symptoms indicate more advanced disease and are formally used in lymphoma staging 2
Patients with B symptoms often have more aggressive disease and poorer outcomes
Clinical Presentation and Evaluation
When evaluating a patient with suspected Hodgkin lymphoma, careful assessment for B symptoms is essential:
- Fever: Document pattern, frequency, and maximum temperature (must be >38°C)
- Night sweats: Must be drenching (requiring change of bedclothes/sheets)
- Weight loss: Document amount and timeframe (must be >10% over 6 months)
Additional symptoms that may accompany B symptoms but are not part of the formal B symptom definition include:
- Alcohol-induced pain (pain at lymphoma sites after alcohol consumption)
- Pruritus (itching)
- Fatigue
- Poor performance status 1
Prognostic Implications
B symptoms significantly impact prognosis and treatment decisions:
- Patients with both fever and weight loss have shown particularly poor outcomes with a 7-year survival and freedom from relapse of only 57% and 48%, respectively 3
- Night sweats alone may have less prognostic impact than the other B symptoms 3
- The presence of B symptoms is one of the unfavorable factors used to classify early-stage HL as "unfavorable" 1
- B symptoms help stratify patients into treatment categories:
- Early-stage favorable (stage I-II with no B symptoms or other unfavorable factors)
- Early-stage unfavorable (stage I-II with B symptoms or other unfavorable factors)
- Advanced-stage disease (stage III-IV) 1
Clinical Application
The presence of B symptoms guides clinical decision-making:
- Patients with early-stage disease but with B symptoms are typically classified as having "unfavorable" disease and may require more intensive treatment
- B symptoms must be distinguished from similar symptoms due to infection or other causes
- Resolution of B symptoms is an important indicator of treatment response
- In patients presenting with unexplained B symptoms, Hodgkin lymphoma should be included in the differential diagnosis, prompting appropriate workup including physical examination of all lymphoid regions 1
Important Considerations
- B symptoms must be unexplained by infection or other causes
- Documentation of B symptoms should be precise and quantitative when possible
- The presence of B symptoms should trigger a thorough evaluation for extent of disease
- B symptoms typically resolve with effective treatment of the underlying lymphoma
Understanding and properly identifying B symptoms is crucial for accurate staging, prognostication, and treatment planning in patients with Hodgkin lymphoma.