Clinical Features of Hodgkin Lymphoma

Part of the Molecular Pathology Library book series (MPLB)


Hodgkin lymphoma patients typically present with lymphadenopathy that involves lymph node sites in a contiguous fashion, while extranodal sites of disease are less common. Systemic symptoms including fevers, drenching night sweats, weight loss, and pruritus may be present at diagnosis. A comprehensive clinical evaluation is important prior to therapy to confirm the stage of disease, identify adverse prognostic factors and anticipate complications due to comorbid conditions. Information gleaned from the careful assessment of the patient, and from radiological and laboratory testing, will allow for an appropriate selection of therapy. Imaging studies, particularly the use of PET scans, are an important part of this initial clinical evaluation but are also critical during and after therapy to evaluate response for prognostic purposes. Because the outcome of Hodgkin lymphoma patients is usually good and many patients may be cured, long-term follow-up of patients is necessary to detect and manage potential complications of therapy.


Hodgkin lymphoma Clinical features Prognostic factors Survivorship 


  1. Aleman BM, van den Belt-Dusebout AW, Klokman WJ et al (2003) Long-term cause-specific mortality of patients treated for Hodgkin’s disease. J Clin Oncol 21(18):3431–3439CrossRefPubMedGoogle Scholar
  2. Ansell SM (2016) Hodgkin lymphoma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol 91(4):434–442CrossRefPubMedGoogle Scholar
  3. Ballova V, Ruffer JU, Haverkamp H et al (2005) A prospectively randomized trial carried out by the German Hodgkin Study Group (GHSG) for elderly patients with advanced Hodgkin’s disease comparing BEACOPP baseline and COPP-ABVD (study HD9elderly). Ann Oncol 16(1):124–131CrossRefPubMedGoogle Scholar
  4. Barry RM, Diamond HD, Craver LF (1962) Influence of pregnancy on the course of Hodgkin’s disease. Am J Obstet Gynecol 84:445–454CrossRefPubMedGoogle Scholar
  5. Behringer K, Wildt L, Mueller H et al (2010) No protection of the ovarian follicle pool with the use of GnRH-analogues or oral contraceptives in young women treated with escalated BEACOPP for advanced-stage Hodgkin lymphoma. Final results of a phase II trial from the German Hodgkin Study Group. Ann Oncol 21(10):2052–2060CrossRefPubMedGoogle Scholar
  6. Behringer K, Mueller H, Goergen H et al (2013) Gonadal function and fertility in survivors after Hodgkin lymphoma treatment within the German Hodgkin Study Group HD13 to HD15 trials. J Clin Oncol 31(2):231–239CrossRefPubMedGoogle Scholar
  7. Boll B, Bredenfeld H, Gorgen H et al (2011) Phase 2 study of PVAG (prednisone, vinblastine, doxorubicin, gemcitabine) in elderly patients with early unfavorable or advanced stage Hodgkin lymphoma. Blood 118(24):6292–6298CrossRefPubMedGoogle Scholar
  8. Cheson BD, Fisher RI, Barrington SF et al (2014) Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 32(27):3059–3068CrossRefPubMedPubMedCentralGoogle Scholar
  9. De Bruin ML, Dorresteijn LD, van’t Veer MB et al (2009) Increased risk of stroke and transient ischemic attack in 5-year survivors of Hodgkin lymphoma. J Natl Cancer Inst 101(13):928–937CrossRefPubMedGoogle Scholar
  10. Diehl LF, Hopper KD, Giguere J et al (1991) The pattern of intrathoracic Hodgkin’s disease assessed by computed tomography. J Clin Oncol 9(3):438–443CrossRefPubMedGoogle Scholar
  11. Diehl V, Stein H, Hummel M, Zollinger R, Connors JM (2003) Hodgkin’s lymphoma: biology and treatment strategies for primary, refractory, and relapsed disease. Hematology Am Soc Hematol Educ Program 225–247Google Scholar
  12. Doll DC, Ringenberg QS, Yarbro JW (1989) Antineoplastic agents and pregnancy. Semin Oncol 16(5):337–346PubMedGoogle Scholar
  13. Ekstrand BC, Horning SJ (2002 Jun) Hodgkin’s disease. Blood Rev 16(2):111–117CrossRefPubMedGoogle Scholar
  14. Elbl L, Vasova I, Kral Z et al (2006) Evaluation of acute and early cardiotoxicity in survivors of Hodgkin’s disease treated with ABVD or BEACOPP regimens. J Chemother 18(2):199–208CrossRefPubMedGoogle Scholar
  15. Engels EA, Pfeiffer RM, Goedert JJ et al (2006) Trends in cancer risk among people with AIDS in the United States 1980-2002. AIDS 20(12):1645–1654CrossRefPubMedGoogle Scholar
  16. Evens AM, Hong F, Gordon LI et al (2013) The efficacy and tolerability of adriamycin, bleomycin, vinblastine, dacarbazine and Stanford V in older Hodgkin lymphoma patients: a comprehensive analysis from the North American intergroup trial E2496. Br J Haematol 161(1):76–86CrossRefPubMedPubMedCentralGoogle Scholar
  17. Fialk MA, Jarowski CI, Coleman M et al (1979) Hepatic Hodgkin’s disease without involvement of the spleen. Cancer 43(3):1146–1147CrossRefPubMedGoogle Scholar
  18. Franklin J, Pluetschow A, Paus M et al (2006) Second malignancy risk associated with treatment of Hodgkin’s lymphoma: meta-analysis of the randomised trials. Ann Oncol 17(12):1749–1760CrossRefPubMedGoogle Scholar
  19. Gallamini A, Hutchings M, Rigacci L et al (2007) Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin’s lymphoma: a report from a joint Italian-Danish study. J Clin Oncol 25:3746–3752CrossRefPubMedGoogle Scholar
  20. Goodman KA, Riedel E, Serrano V et al (2008) Long-term effects of high-dose chemotherapy and radiation for relapsed and refractory Hodgkin’s lymphoma. J Clin Oncol 26(32):5240–5247CrossRefPubMedGoogle Scholar
  21. Guadagnolo BA, Punglia RS, Kuntz KM et al (2006) Cost-effectiveness analysis of computerized tomography in the routine follow-up of patients after primary treatment for Hodgkin’s disease. J Clin Oncol 24(25):4116–4122CrossRefPubMedGoogle Scholar
  22. Hancock SL, Scidmore NS, Hopkins KL et al (1994) Computed tomography assessment of splenic size as a predictor of splenic weight and disease involvement in laparotomy staged Hodgkin’s disease. Int J Radiat Oncol Biol Phys 28(1):93–99CrossRefPubMedGoogle Scholar
  23. Hartmann P, Rehwald U, Salzberger B et al (2003) BEACOPP therapeutic regimen for patients with Hodgkin’s disease and HIV infection. Ann Oncol 14(10):1562–1569CrossRefPubMedGoogle Scholar
  24. Hasenclever D, Diehl V, Armitage JO et al (1998) A prognostic score for advanced Hodgkin’s disease. International prognostic factors project on advanced Hodgkin’s disease. N Engl J Med 339(21):1506–1514CrossRefPubMedGoogle Scholar
  25. Hutchings M, Loft A, Hansen M et al (2006) FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood 107:52–59CrossRefPubMedGoogle Scholar
  26. Jerusalem G, Beguin Y, Fassotte MF et al (1999) Whole-body positron emission tomography using 18F-fluorodeoxyglucose for posttreatment evaluation in Hodgkin’s disease and non-Hodgkin’s lymphoma has higher diagnostic and prognostic value than classical computed tomography scan imaging. Blood 94:429–433PubMedGoogle Scholar
  27. Jerusalem G, Beguin Y, Fassotte MF et al (2001) Whole-body positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures for staging patients with Hodgkin’s disease. Haematologica 86(3):266–273PubMedGoogle Scholar
  28. Kaplan HS (1971) Contiguity and progression in Hodgkin’s disease. Cancer Res 31(11):1811–1813PubMedGoogle Scholar
  29. Kaplan HS, Dorfman RF, Nelsen TS et al (1973) Staging laparotomy and splenectomy in Hodgkin’s disease: analysis of indications and patterns of involvement in 285 consecutive, unselected patients. Natl Cancer Inst Monogr 36:291–301PubMedGoogle Scholar
  30. Kostakoglu L, Leonard JP, Coleman M et al (2004) The role of FDG-PET imaging in the management of lymphoma. Clin Adv Hematol Oncol 2(2):115–121PubMedGoogle Scholar
  31. Krikorian JG, Portlock CS, Mauch PM (1986) Hodgkin’s disease presenting below the diaphragm: a review. J Clin Oncol 4(10):1551–1562CrossRefPubMedGoogle Scholar
  32. Krull KR, Sabin ND, Reddick WE et al (2012) Neurocognitive function and CNS integrity in adult survivors of childhood Hodgkin lymphoma. J Clin Oncol 30(29):3618–3624CrossRefPubMedPubMedCentralGoogle Scholar
  33. Leibenhaut MH, Hoppe RT, Varghese A et al (1987) Subdiaphragmatic Hodgkin’s disease: laparotomy and treatment results in 49 patients. J Clin Oncol 5(7):1050–1055CrossRefPubMedGoogle Scholar
  34. Levine AM (1998) Hodgkin’s disease in the setting of human immunodeficiency virus infection. J Natl Cancer Inst Monogr (23):37–42Google Scholar
  35. Lister TA, Crowther D (1990) Staging for Hodgkin’s disease. Semin Oncol 17(6):696–703PubMedGoogle Scholar
  36. Lister TA, Crowther D, Sutcliffe SB et al (1989) Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: cotswolds meeting. J Clin Oncol 7(11):1630–1636CrossRefPubMedGoogle Scholar
  37. Mauch PM, Kalish LA, Kadin M et al (1993) Patterns of presentation of Hodgkin disease. Implications for etiology and pathogenesis. Cancer 71(6):2062–2071CrossRefPubMedGoogle Scholar
  38. Munker R, Hasenclever D, Brosteanu O et al (1995) Bone marrow involvement in Hodgkin’s disease: an analysis of 135 consecutive cases. German Hodgkin’s Lymphoma Study Group. J Clin Oncol 13(2):403–409CrossRefPubMedGoogle Scholar
  39. Musshoff K (1971) Prognostic and therapeutic implications of staging in extranodal Hodgkin’s disease. Cancer Res 31(11):1814–1827PubMedGoogle Scholar
  40. Ng AK, Bernardo MV, Weller E et al (2002a) Second malignancy after Hodgkin disease treated with radiation therapy with or without chemotherapy: long-term risks and risk factors. Blood 100(6):1989–1996CrossRefPubMedGoogle Scholar
  41. Ng AK, Bernardo MP, Weller E et al (2002b) Long-term survival and competing causes of death in patients with early-stage Hodgkin’s disease treated at age 50 or younger. J Clin Oncol 20(8):2101–2108CrossRefPubMedGoogle Scholar
  42. Ng A, Constine LS, Advani R et al (2010) ACR appropriateness criteria: follow-up of Hodgkin’s lymphoma. Curr Probl Cancer 34(3):211–227CrossRefPubMedGoogle Scholar
  43. Okosun J, Warbey V, Shaw K et al (2012) Interim fluoro-2-deoxy-D-glucose-PET predicts response and progression-free survival in patients with Hodgkin lymphoma and HIV infection. AIDS 26(7):861–865CrossRefPubMedGoogle Scholar
  44. Rosenberg SA (1971) Hodgkin’s disease of the bone marrow. Cancer Res 31(11):1733–1736PubMedGoogle Scholar
  45. Seam P, Juweid ME, Cheson BD (2007) The role of FDG-PET scans in patients with lymphoma. Blood 110(10):3507–3516CrossRefPubMedGoogle Scholar
  46. Shiels MS, Cole SR, Kirk GD et al (2009) A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr 52(5):611–622CrossRefPubMedPubMedCentralGoogle Scholar
  47. Sieniawski M, Reineke T, Josting A et al (2008) Assessment of male fertility in patients with Hodgkin’s lymphoma treated in the German Hodgkin Study Group (GHSG) clinical trials. Ann Oncol 19(10):1795–1801CrossRefPubMedGoogle Scholar
  48. Thompson CA, Ghesquieres H, Maurer MJ et al (2014) Utility of routine post-therapy surveillance imaging in diffuse large B-cell lymphoma. J Clin Oncol 32(31):3506–3512CrossRefPubMedPubMedCentralGoogle Scholar
  49. Torrey MJ, Poen JC, Hoppe RT (1997) Detection of relapse in early-stage Hodgkin’s disease: role of routine follow-up studies. J Clin Oncol 15(3):1123–1130CrossRefPubMedGoogle Scholar
  50. Tsai HR, Gjesdal O, Wethal T et al (2011) Left ventricular function assessed by two-dimensional speckle tracking echocardiography in long-term survivors of Hodgkin’s lymphoma treated by mediastinal radiotherapy with or without anthracycline therapy. Am J Cardiol 107(3):472–477CrossRefPubMedGoogle Scholar
  51. Tubiana M, Henry-Amar M, Carde P et al (1989) Toward comprehensive management tailored to prognostic factors of patients with clinical stages I and II in Hodgkin’s disease. The EORTC Lymphoma Group controlled clinical trials: 1964-1987. Blood 73(1):47–56PubMedGoogle Scholar
  52. van Beek RD, van den Heuvel-Eibrink MM, Hakvoort-Cammel FG et al (2009) Bone mineral density, growth, and thyroid function in long-term survivors of pediatric Hodgkin’s lymphoma treated with chemotherapy only. J Clin Endocrinol Metab 94(6):1904–1909CrossRefPubMedGoogle Scholar
  53. Xicoy B, Ribera JM, Miralles P et al (2007) Results of treatment with doxorubicin, bleomycin, vinblastine and dacarbazine and highly active antiretroviral therapy in advanced stage, human immunodeficiency virus-related Hodgkin’s lymphoma. Haematologica 92(2):191–198CrossRefPubMedGoogle Scholar
  54. Zinzani PL, Magagnoli M, Chierichetti F et al (1999) The role of positron emission tomography (PET) in the management of lymphoma patients. Ann Oncol 10:1181–1184CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of HematologyMayo ClinicRochesterUSA

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