Hodgkin's lymphoma

Hodgkin's lymphoma or malignant lymphogranuloma, is a cancer of the lymphatic tissue. The etiology is unknown (genetic predisposition, immune disorder, EBV , HIV ). It is most often diagnosed between the ages of 20 and 30, and the incidence rises again after the age of 50. The disease breaks out in the lymph node (most often in the axial distribution), from where it spreads to neighboring nodes as well as to the systemic circulation.

Mikroskopický obraz: buňka Reedové a Sternberga - "owl eyes"

Histologically, they are divided according to the number of Reed-Sternberg mutations B-cell ) and according to the degree of cellular response:


 * type I predominance lymphocyte (few RS cells, many lymphocytes ; best prognosis) (5%);
 * type II nodular-sclerotic (nodular foci, cells (reticular, lymphocytes, histiocytes) in collagen fibers) (70%);
 * type III mixed (20-25%);
 * type IV classic, lymphocyte-poor (Sternberg cells proliferated; worst prognosis) (1%).

Clinical picture

 * Painless enlargement of the nodes (cervical, axillary, inguinal);
 * fever (typical of Pelova-Ebstein ), itching, sweating, malaise, fatigue, weight loss;
 * splenomegaly ;
 * cough, dyspnoea, upper vena cava syndrome involvement mediastinal );
 * effusion, infiltration of parenchymal organs, skeleton (in advanced disability).

Diagnosis

 * Nodular extirpation and its subsequent histopathological examination - the presence of RS cells or Hodgkin's cells (RS cell precursors);
 * ray, sono abdominal scintigraphy of liver, spleen, CT and lymphography , PET ;
 * trepanobiopsy of bone marrow

Stages

 * Stage I (involvement of one lymphatic area or one extralymphatic organ);
 * stage II (affecting two or more areas on one side of the diaphragm);
 * stage III (involvement of lymph nodes on both sides of the diaphragm, including the extralymphatic organ or spleen);
 * stage IV (disseminated involvement of extralymphatic organs independent of nodal involvement).
 * Furthermore, each stage is divided into A and B:
 * A - the patient is without general symptoms;
 * B - with general symptoms (weight loss of 10% in 6 months, fever more than 38 ° C, night sweats)

Complications

 * Infections, spinal cord compression when affecting the vertebrae.

Therapy
The basic treatment modality is systemic treatment in the form of combined chemotherapy, in localized stages we supplement it with radiotherapy. Basic regimens used: ABVD (adriamycin, bleomycin, vinblastine, decarbazine), BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone).


 * Localized (early) stages I, II: with favorable prognosis (without risk factors) 2 × ABVD and radiotherapy 20 Gy, with unfavorable prognosis (with risk factors) 2 × BEACOPP + 2 × ABVD and radiotherapy 20 Gy.
 * Advanced Stages III, IV: 6 × BEACOPP escalated mode.
 * In case of relapse - a rescue regimen (based on platinum derivatives), autologous transplantation.
 * New drugs is used to treat relapses brentuximab vedotin (anti-CD30 antibody)

Prognosis
Patients have a good prognosis, about 70-80% of patients recover. The tumor has good curability.

Related

 * Malignant lymphoma
 * Non-Hodgkin's malignant lymphomas
 * Diffuse large B-cell lymphoma
 * Leukemia
 * Chemotherapy
 * Radiotherapy

Literature

 * CZECH, Richard, et al. Internal. 2nd edition. Prague: Triton, 2015. 909 pp. ISBN 978-80-7387-895-5.
 * KLENER, Pavel, et al. Internal Medicine. 4th edition. Prague: Galén, Karolinum, 2011. 1174 pp. ISBN 978-80-7262-705-9.