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| Classical Hodgkin lymphoma | |
|---|---|
| Name | Classical Hodgkin lymphoma |
| Field | Hematology, Oncology |
| Symptoms | Painless lymphadenopathy, fever, night sweats, weight loss |
| Complications | Secondary malignancy, infection |
| Onset | Adolescence, young adulthood, older adulthood |
| Risks | Epstein–Barr virus, family history, immunosuppression |
| Diagnosis | Lymph node biopsy, immunohistochemistry |
| Treatment | Chemotherapy, radiotherapy, immunotherapy |
Classical Hodgkin lymphoma is a B‑cell–derived malignancy of the lymphatic system characterized by malignant Reed–Sternberg cells in an inflammatory background. It typically presents with nodal enlargement and systemic "B" symptoms, and is treated by combinations of chemotherapy, radiotherapy, and targeted immunotherapies with overall favorable survival in developed settings.
Patients most often present with painless cervical, mediastinal, or axillary lymphadenopathy and systemic features such as fever, night sweats, and weight loss; these manifestations can be seen in cohorts from United Kingdom, United States, Germany, Japan, and Brazil. Mediastinal mass effects including cough, dyspnea, or superior vena cava syndrome are reported in series from France, Italy, Canada, Sweden, and Australia. Extranodal symptoms such as splenomegaly or pruritus appear in case reports from Spain, India, South Africa, Mexico, and Netherlands; paraneoplastic syndromes and treatment‑related complications have been described in literature from Switzerland, Belgium, Denmark, Norway, and Finland.
Histopathology shows large binucleated Reed–Sternberg cells in a reactive infiltrate; core descriptions appear in textbooks used at Johns Hopkins Hospital, Mayo Clinic, Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, and Dana‑Farber Cancer Institute. Classical subtypes include nodular sclerosis, mixed cellularity, lymphocyte‑rich, and lymphocyte‑depleted, with subtype frequencies reported in registries from SEER Program, National Cancer Institute, European Cancer Registry, WHO, and International Agency for Research on Cancer. Immunophenotyping demonstrates CD15 and CD30 positivity with variable CD20 and PAX5 expression; immunohistochemical panels and diagnostic algorithms are taught in curricula at Harvard Medical School, University of Oxford, University of Cambridge, Karolinska Institutet, and University of Tokyo. Electron microscopy and flow cytometry contributions were developed in research centers such as Fred Hutchinson Cancer Center, Institut Gustave Roussy, Peter MacCallum Cancer Centre, Institut Curie, and St. Jude Children’s Research Hospital.
Definitive diagnosis relies on excisional lymph node biopsy interpreted by hematopathologists at institutions like Royal Marsden Hospital, Cleveland Clinic, Vanderbilt University Medical Center, University of Pennsylvania, and Stanford University Medical Center. Staging investigations commonly include PET‑CT and contrast CT scans performed with protocols from American Society of Clinical Oncology, European Society for Medical Oncology, National Comprehensive Cancer Network, International Atomic Energy Agency, and World Health Organization. Laboratory evaluation frequently references guidelines from American Society of Hematology, British Society for Haematology, Society of Pediatric Oncology, Children’s Oncology Group, and European Hematology Association.
Staging follows the Ann Arbor system with modifications used in clinical trials coordinated by European Organisation for Research and Treatment of Cancer, Groupe d'Etudes des Lymphomes de l'Adulte, Eastern Cooperative Oncology Group, Children’s Oncology Group, and UK NCRI. Prognostic scoring incorporates bulky disease, B symptoms, and international prognostic indices validated in cohorts from Sweden, Norway, Iceland, Finland, and Denmark. Long‑term outcomes and survivorship issues have been studied in registry analyses from SEER Program, Cancer Research UK, Institut National du Cancer, Australian Institute of Health and Welfare, and Health Canada.
First‑line regimens include ABVD and escalated BEACOPP protocols developed and compared in trials by German Hodgkin Study Group, National Cancer Institute, EORTC, Children’s Oncology Group, and UK NCRI. Radiotherapy approaches and involved‑node techniques are based on trials from MD Anderson Cancer Center, Memorial Sloan Kettering Cancer Center, Royal Marsden Hospital, Institut Gustave Roussy, and Peter MacCallum Cancer Centre. Salvage strategies employ autologous stem cell transplantation and checkpoint inhibitors such as nivolumab and pembrolizumab tested in studies from FDA, EMA, NCI, FDA Oncology Center of Excellence, and European Medicines Agency. Brentuximab vedotin is adopted from multicenter trials led by Seattle Cancer Care Alliance, Dana‑Farber Cancer Institute, Mayo Clinic, University College London, and University of Milan.
Incidence shows a bimodal age distribution with peaks in adolescence/young adulthood and older age groups documented in surveillance reports from SEER Program, Cancer Research UK, European Cancer Observatory, WHO, and IARC. Risk factors include prior infection with Epstein–Barr virus noted in seroepidemiologic studies from CDC, WHO, Institut Pasteur, Karolinska Institutet, and Johns Hopkins Bloomberg School of Public Health; familial predisposition and HLA associations have been reported in genetic studies from Oxford University, University of Cambridge, Harvard School of Public Health, University of Copenhagen, and McGill University. Immunosuppression‑related cases occur in registries from HIV/AIDS Program, Centers for Disease Control and Prevention, National Health Service, Agence Nationale de Sécurité du Médicament, and transplant cohorts at Mayo Clinic.
Neoplastic cells exhibit JAK‑STAT pathway activation, NF‑κB signaling, and constitutive PD‑L1/PD‑L2 expression through 9p24.1 alterations described in genomic studies from Broad Institute, Wellcome Sanger Institute, Cold Spring Harbor Laboratory, NIH, and European Bioinformatics Institute. Epstein–Barr virus latency programs and viral oncogenes have been characterized in investigations at Institut Pasteur, Rockefeller University, University of Pennsylvania Perelman School of Medicine, Yale School of Medicine, and University of California, San Francisco. High‑throughput sequencing and copy‑number analyses from consortia including The Cancer Genome Atlas, International Cancer Genome Consortium, Genomics England, 1000 Genomes Project, and ENCODE Project elucidate recurrent mutations and microenvironmental interactions targeted by therapies developed at Novartis, Roche, Merck, Bristol‑Myers Squibb, and AbbVie.