Hodgkin Lymphoma

• Hodgkin Lymphoma (HL) is a rare type of hematologic malignancy that accounts for 6-7% of all pediatric cancers. 
• Peak incidence occurs in the adolescent and young adult years, making HL one of the most common malignancies occurring in the 15-19-year-old age group. 
• Risk factors for developing HL include prior infection with Epstein-Barr virus and immunocompromising conditions, including immunosuppression after organ transplantation or HIV infection.
• Over the past several decades, treatment of Hodgkin lymphoma has improved with current 5-year survival estimates of approximately 90%.
• Despite the triumphs made in increasing 5-year survival, treatment with radiation and conventional chemotherapy has come at a cost. 
• Late effects of these treatment modalities have resulted in higher rates of morbidity and mortality in long-term survivors compared to the general population, driving the need to develop safer treatment options with sustained disease control for pediatric patients with Hodgkin lymphoma.
• Upon initial presentation of a patient with suspected HL, a thorough history and physical examination should be performed, including specific, targeted questions inquiring about the presence of B symptoms.. 
• B symptoms include unexplained recurrent high fevers (> 38C) within the past month, drenching night sweats within the past month, and weight loss of > 10% of body weight within 6 months prior to diagnosis.
• The initial workup should also include at a minimum, standard laboratory test, such as a complete blood count (CBC) with differential; comprehensive metabolic panel (CMP), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). 
• Additionally, females of childbearing age should receive a pregnancy test before starting treatment with chemotherapy.
• To definitively determine a diagnosis of HL, a biopsy is needed. NCCN guidelines recommend an excisional or incisional lymph node biopsy be performed. A core needle biopsy may be adequate.
• It is recommended that specimens be stained to detect CD 30, CD 15, CD 20, and CD 3, although an expanded panel of markers (CD 45, CD 79a, ALK, MUM1. OCT2, BOB1) should be considered to aid in determining diagnosis in cases where a definitive diagnosis is not obtained.