Hodgkins Lymphoma

Hodgkins Lymphoma is a cancer of the lymphatic system - the network of lymph glands and channels which occurs throughout the body. This collects lymph - fluid that bathes all the body cells. The lymphatic system is also a very important part of the immune system which keeps the body free of infection. The lymph fluid contains white blood cells called Lymphocytes which can be classified into sub-groups according to their function, the main groups are B-cells and T-cells. Different types of lymphocytes produce antibodies and directly destroy some infecting organisms, especially viruses. Tumours of the lymphatic tissues are known as lymphomas.

The defining feature of Hodgkins Lymphoma is the presence of a distinctive abnormal lymphocyte called a Reed-Sternberg cell, which make up 1 in 1000 of the cells in a tumour. Hodgkins Lymphoma has a very high cure rate, especially in younger patients diagnosed with early stage disease. In this group the cure rate may approach 100%.

Signs and Symptoms: A significant proportion of patients with HL have no obvious symptoms or signs at the time of diagnosis. Their disease is discovered as a result of investigations carried out for other reasons e.g. a routine chest X-ray. The most obvious sign is swollen lymph nodes in the neck, collarbone region, armpits, and groin. But these can also be diagnosed as easily treated infections. At later stages of the disease more generalised symptoms develop such as night sweats, fatigue, weight loss, reccurant fevers, headaches, and itching.
The only definite way to diagnose Hodgkins is to obtain Histological proof (a biopsy).

Staging: Hodgkins is staged depending on how far the disease has progressed. a B is added onto the end of the stage if the patient has experienced symptoms.
Stage 1 - The disease is isolated to 1 area. For example, one side of the neck.
Stage 2 - The disease has spread to more than one area above the diaphragm. For example, both sides of the neck and chest.
Stage 3 - The disease has spread both above and below the diaphragm. For example, in the neck, chest, and spleen.
Stage 4 - The disease is wide spread across the body and even in areas where lymph nodes are not present. For example, above and below the diaphragm, and in the bone marrow.

Treatment: At very early stages of the disease where perhaps on one isolated node is present, it is possible to be treated with radiotherapy alone. However the preferred choice is 6-8 months of ABVD chemotherapy depending on the stage of disease, and possibly followed by about a month of consolidative radiotherapy.
In the occurance of a relapse after remission has been achieved, the preferred choice is to commence with salvage chemotherapy (much stronger than ABVD), and then high-dose chemotherapy (BEAM or LACE) followed by either an autologous (patients own stem cells) or allogeinic (donor cells) transplant. With autologous stem cell transplants there is always the risk of contaminated lymphoma cells being returned to the patient after the high-dose therapy, so therefore the the progression-free survival rate for an allogeinic transplant is significantly higher. Another major advantage of an allogeneic transplant is the possible provision of a graft verses Hodgkins effect in which the doner cells attack any remaining Hodgkins cells. However there is also the significant risk of graft verses host disease, although this can be easily controlled if caught quickly.

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