What is the most common variant of Hodgkin's Lymphoma (HL) in India?

Most Common Hodgkin's Lymphoma Variant in India

Mixed cellularity is the most common histological subtype of Hodgkin's lymphoma in India, accounting for approximately 50-55% of all cases. 1, 2

Epidemiological Profile of Hodgkin's Lymphoma in India

The epidemiological profile of Hodgkin's lymphoma (HL) in India differs significantly from Western countries in several key aspects:

• Histological distribution:

  • Mixed cellularity: 45.8-54% of cases 1, 2
  • Lymphocyte depleted: Together with mixed cellularity forms 68% of all HL cases 1
  • Nodular sclerosis: Only 9% of cases in India 1, compared to being the predominant subtype in Western countries

• Age distribution:

  • Bimodal age pattern with peak in the second decade of life 1
  • Median age of onset around 28 years 2
  • Higher incidence in childhood compared to Western countries 1

• Gender distribution:

  • Strong male predominance with male-to-female ratio of 3.8:1 2

Comparison with Western Patterns

In Western countries, the pattern of Hodgkin's lymphoma differs considerably:

• Nodular sclerosis is the predominant subtype in Western populations 3, 4
• Bimodal age distribution with first peak in third decade and second peak after age 55 5, 6
• Incidence of 2-3/100,000 per year 5

Clinical Presentation in Indian Population

The clinical presentation of Hodgkin's lymphoma in Indian patients typically includes:

• Neck swelling as the most common symptom (58.3%) 2
• Peripheral lymphadenopathy as the most common sign (83.3%) 2
• Cervical lymph node involvement in 79.2% of cases 2
• Advanced disease at presentation (54.2% in Stage III/IV) 2
• Bone marrow involvement in 8.33% of cases 2

Significance for Clinical Practice

The predominance of mixed cellularity subtype in India has important clinical implications:

• Mixed cellularity is generally associated with more advanced disease at presentation 7
• This subtype often requires more aggressive treatment approaches
• Understanding this epidemiological pattern helps in developing appropriate regional treatment protocols

Historical Perspective

A comprehensive review of 1082 cases of Hodgkin's disease recorded at the Tata Memorial Hospital in Bombay over 35 years confirmed that mixed cellularity was consistently the most frequent histological subtype in India 1. This pattern aligns with what Correa and O'Connor described as the "type-I pattern" of Hodgkin's disease, which appears to be characteristic of developing countries 1.

The distinct clinicopathologic profile of Hodgkin's lymphoma in India emphasizes the importance of understanding regional variations in disease presentation for appropriate diagnosis and management, particularly in rural communities with limited access to sophisticated medical services 2.