Hodgkin Lymphoma

Pt with h/o immunosuppression including HIV presents with painless lymphadenopathy. Reports cough, night sweats, unintentional weight loss. Family history positive for Hodgkin lymphoma. Low grade fever and painless cervical lymphadenopathy on exam.

• Obtain CXR and chest CT; consider PET scan

• Lymph node biopsy shows Reed-sternberg cells

• Refer to hematology/oncology

• Pt counseled that chemotherapy may result in cardiovascular complications, infertility, and/or premature menopause

• Pt informed that survival rate depends on staging, but is >80% at 5 years overall

• Pt counseled about importance of follow-up as lymphoma recurrence generally happens within a few years after therapy

• Monitoring s/p chemotherapy and radiation

  • Obtain CXR at 6, 12, and 24 months s/p completion of chemotherapy

  • Neck irradiation performed during treatment: Obtain TSH level at 1, 2 and 5 years

Notes

• B cell lymphoma

• Immunosuppressed patients are 10 times greater risk for developing condition

• Subtypes include

  • Nodular sclerosis: Approximately 70% of cases and more common in adolescents

  • Mixed cellularity: 20-25% of cases and more common in younger children and older adults

• ABVD: Commonly used chemotherapy regimen consisting of doxorubicin, bleomycin, vinblastine, and dacarbazine