Classic Hodgkin lymphoma

Classic Hodgkin lymphoma is confirmed with a biopsy of a swollen lymph node. Removing the whole node (an excisional biopsy) is preferred when possible, though part of a node or a core needle sample may be used. A lab doctor (pathologist) looks for large abnormal cells called Hodgkin and Reed-Sternberg cells. Marker tests (immunophenotyping) confirm the type. Classic Hodgkin cells are typically positive for CD30 and CD15 and negative for CD20.

Blood tests include a complete blood count, blood chemistry with LDH, the sedimentation rate (a sign of inflammation), and tests for HIV and hepatitis B and C. A PET-CT scan, or a CT scan, shows which lymph node groups and organs are involved. For newly diagnosed Hodgkin lymphoma, PET-CT has largely replaced a bone marrow biopsy for staging.

The stage and a short list of risk factors, such as a large chest mass or B symptoms (fever, night sweats, weight loss), place a person in an early favorable, early unfavorable or advanced group. That group guides how much treatment is given. During pregnancy, MRI and ultrasound are used to avoid exposing the baby to radiation.

Initial treatment uses combination drug therapy, with radiotherapy in selected circumstances. The regimen may include chemotherapy, brentuximab vedotin or a PD-1 checkpoint inhibitor according to stage, age and clinical context. Response-adapted approaches try to control the lymphoma while limiting late effects.

For relapse or refractory disease, salvage treatment often aims to achieve a response followed by high-dose chemotherapy and autologous stem cell rescue. This is an established approach for eligible patients and uses their own cells.

Allogeneic transplantation is considered for selected patients after failure of autologous treatment or other approaches. Checkpoint inhibitors and other medicines can produce substantial responses and affect transplant timing; prior immunotherapy also needs to be considered when planning a donor transplant.

The outlook for classic Hodgkin lymphoma is good for most people. NCI says up to 90% of people with newly diagnosed Hodgkin lymphoma can be cured with chemotherapy, radiation or both. Outlook depends on stage, B symptoms, blood test results, age and general health. How the lymphoma responds matters too. A PET-CT scan after two cycles of chemotherapy is the best single predictor of whether treatment will work.

Children and teens do especially well: NCI says about 90% to 95% can be cured. People older than 60 may have more side effects from treatment, which can make full-dose treatment harder.

If the lymphoma comes back, cure is still possible. NCI reports that more than half of people with relapsed Hodgkin lymphoma can have long-term disease-free survival, or even cure, with more chemotherapy followed by a stem cell transplant. That transplant most often uses the person's own cells. European transplant experts report that adding brentuximab vedotin and checkpoint inhibitors before transplant helps more people reach a complete remission first. Long-term follow-up matters, because treatment can raise the risk of heart problems and second cancers years later.