Hodgkin Lymphoma

Obtain an excisional biopsy of the most accessible abnormal lymph node when feasible. Excision preserves nodal architecture, permits full histologic assessment, and allows flow cytometry and molecular studies to be directed by the pathologic differential; it remains the diagnostic reference procedure for malignant lymphomas.ccjmccjmComplete Issue (PDF) Core-needle biopsy may be necessary for deep or unsafe nodal targets, but nondiagnostic or discordant core results should lead to excision rather than empiric lymphoma treatment.ScienceDirect+1ScienceDirectDiagnostic challenges and considerations in CD30-negative classical Hodgkin lymphoma from biopsy specimens - ScienceDirectccjmComplete Issue (PDF)

For classical Hodgkin lymphoma (cHL), correlate morphology with immunohistochemistry rather than relying on CD30 alone. Hodgkin/Reed-Sternberg cells commonly coexpress CD30 and CD15, show weak PAX5 expression, and lack CD45; CD20 may be absent or variable.Wolters Kluwer+2Wolters KluwerHodgkin Lymphoma Treatment With Brentuximab... : eJHaemWileyUse of an expanded immunohistochemical panel to distinguish cutaneous Hodgkin lymphoma from histopathologic imitators - Cho - 2012 - Journal of Cutaneous Pathology - Wiley Online LibraryccjmComplete Issue (PDF) CD15-negative cHL occurs, so absent CD15 should trigger expanded evaluation rather than automatic exclusion of cHL.WileyWileyUse of an expanded immunohistochemical panel to distinguish cutaneous Hodgkin lymphoma from histopathologic imitators - Cho - 2012 - Journal of Cutaneous Pathology - Wiley Online Library

Escalate the pathology review when the specimen contains Reed-Sternberg-like cells within a population of atypical B cells, because diffuse large B-cell lymphoma and small lymphocytic lymphoma can contain cells with a CD30-strong, PAX5-weak phenotype resembling cHL.Wolters KluwerWolters KluwerORAL PAPER ABSTRACTS : Indian Journal of Pathology and Microbiology A background population that is CD20- and PAX5-positive favors a B-cell non-Hodgkin lymphoma with Reed-Sternberg-like cells rather than cHL.Wolters KluwerWolters KluwerORAL PAPER ABSTRACTS : Indian Journal of Pathology and Microbiology

Perform baseline whole-body FDG-PET/CT after tissue confirmation. The Lugano classification applies FDG-PET/CT to lymphoma staging and response assessment, making the scan the central imaging study for defining nodal and extranodal disease distribution and for comparison with interim or end-of-treatment studies.pubs rsnapubs rsnaImaging for Staging and Response Assessment in ...

Do not routinely add a blind iliac-crest bone marrow biopsy when a newly diagnosed patient with Hodgkin lymphoma has been staged by FDG-PET/CT. A meta-analysis specifically evaluated whether PET/CT can replace blind marrow biopsy in newly diagnosed Hodgkin lymphoma, and an accompanying clinical analysis found that routine marrow biopsy added limited useful information without therapeutic consequences after PET/CT staging.ScienceDirect+1ScienceDirectSystematic review and meta-analysis on the diagnostic performance of FDG-PET/CT in detecting bone marrow involvement in newly diagnosed Hodgkin lymphoma: is bone marrow biopsy still necessary? - ScienceDirectASHStaging DLBCL: bone marrow biopsy or PET-CT? | Blood | American Society of Hematology

Reconsider marrow sampling when PET/CT findings, cytopenias, or an alternative hematologic diagnosis create a question that would change classification or management. PET/CT and single-site biopsy assess marrow differently, and diffuse marrow FDG uptake has uncertain specificity for infiltration; discordance should be resolved in the clinical-pathologic context rather than assumed to represent Hodgkin lymphoma involvement.ScienceDirectScienceDirectWhole body FDG-PET/CT for the assessment of bone marrow infiltration in patients with newly diagnosed lymphoma - ScienceDirect

For early-stage favorable Hodgkin lymphoma, combined-modality therapy can achieve high cure rates with reduced treatment intensity. In a randomized trial, two cycles of ABVD followed by 20 Gy involved-field radiotherapy was an effective regimen for patients with early-stage favorable disease.NEJMNEJMReduced Treatment Intensity in Patients with Early-Stage ... This evidence supports a discussion centered on whether a patient meets the favorable-risk population studied and whether the expected benefit of radiation outweighs site-specific late toxicity.

For stage IA or IIA nonbulky Hodgkin lymphoma, chemotherapy plus radiation controlled disease in approximately 90% of patients in trial evidence, but radiation-based treatment carries late-effect considerations.NEJMNEJMABVD Alone versus Radiation-Based Therapy in Limited ... Chemotherapy-only strategies are therefore a deliberate tradeoff rather than a default: they avoid radiotherapy exposure while accepting a different balance of relapse control, salvage treatment, and long-term toxicity.NEJMNEJMABVD Alone versus Radiation-Based Therapy in Limited ...

Use interim FDG-PET response as part of response-adapted management where the selected protocol incorporates it. PET-guided approaches have been studied to reduce chemotherapy intensity and direct radiotherapy in advanced-stage Hodgkin lymphoma, and contemporary reviews identify interim FDG-PET as a key component of response-adapted therapy.Oxford Academic+1Oxford AcademicHodgkin LymphomaWHOHodgkin Lymphom S3-Leitlinie Diagnostik, Therapie und ... The regimen, scan timing, and PET interpretation framework should follow the specific protocol rather than ad hoc treatment changes.

At suspected relapse or refractory disease, obtain tissue confirmation when an accessible lesion is available and when histology could alter management. This is particularly important after a limited original specimen or when imaging findings are discordant with the clinical course, because CD30-positive non-Hodgkin lymphomas and cHL can overlap morphologically and immunophenotypically.Wiley+1WileyUse of an expanded immunohistochemical panel to distinguish cutaneous Hodgkin lymphoma from histopathologic imitators - Cho - 2012 - Journal of Cutaneous Pathology - Wiley Online LibraryWolters KluwerORAL PAPER ABSTRACTS : Indian Journal of Pathology and Microbiology

Salvage management should distinguish patients being considered for transplant-based therapy from those receiving nontransplant approaches. Contemporary work specifically evaluates transplant and nontransplant salvage strategies in relapsed/refractory Hodgkin lymphoma, while pediatric low-risk relapse studies have examined transplant-free approaches; selection therefore depends on relapse-risk setting and treatment strategy rather than a single universal salvage regimen.JAMA+1JAMATransplant and Nontransplant Salvage Therapy in ...JAMATransplant-Free Salvage Therapy for Low-Risk Relapsed ...

Brentuximab vedotin is a CD30-directed agent relevant to cHL, but this article does not specify a regimen or dose because treatment selection and dosing require protocol- and patient-specific prescribing information. Before using a CD30-directed strategy, confirm tumor classification and CD30 expression in the relevant specimen, especially when pathology is atypical.Wolters Kluwer+2Wolters KluwerHodgkin Lymphoma Treatment With Brentuximab... : eJHaemWileyUse of an expanded immunohistochemical panel to distinguish cutaneous Hodgkin lymphoma from histopathologic imitators - Cho - 2012 - Journal of Cutaneous Pathology - Wiley Online LibraryScienceDirectDiagnostic challenges and considerations in CD30-negative classical Hodgkin lymphoma from biopsy specimens - ScienceDirect