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Review
. 2018 Mar;68(2):116-132.
doi: 10.3322/caac.21438. Epub 2017 Dec 1.

Hodgkin lymphoma: A review and update on recent progress

Satish Shanbhag  1 , Richard F Ambinder  2
Affiliations
Review

Hodgkin lymphoma: A review and update on recent progress

Satish Shanbhag et al. CA Cancer J Clin. 2018 Mar.

Abstract

Hodgkin lymphoma (HL) is a unique hematopoietic neoplasm characterized by cancerous Reed-Sternberg cells in an inflammatory background. Patients are commonly diagnosed with HL in their 20s and 30s, and they present with supradiaphragmatic lymphadenopathy, often with systemic B symptoms. Even in advanced-stage disease, HL is highly curable with combination chemotherapy, radiation, or combined-modality treatment. Although the same doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapeutic regimen has been the mainstay of therapy over the last 30 years, risk-adapted approaches have helped de-escalate therapy in low-risk patients while intensifying treatment for higher risk patients. Even patients who are not cured with initial therapy can often be salvaged with alternate chemotherapy combinations, the novel antibody-drug conjugate brentuximab, or high-dose autologous or allogeneic hematopoietic stem cell transplantation. The programmed death-1 inhibitors nivolumab and pembrolizumab have both demonstrated high response rates and durable remissions in patients with relapsed/refractory HL. Alternate donor sources and reduced-intensity conditioning have made allogeneic hematopoietic stem cell transplantation a viable option for more patients. Future research will look to integrate novel strategies into earlier lines of therapy to improve the HL cure rate and minimize long-term treatment toxicities. CA Cancer J Clin 2018;68:116-132. © 2017 American Cancer Society.

Keywords: Hodgkin lymphoma; allogeneic stem cell transplantation; antibody-drug conjugate; brentuximab; immunotherapy; positron emission tomography (PET)-adapted therapy; programmed death 1 (PD-1) inhibitor.

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Conflict of interest statement

Conflict of Interest Disclosure:

Satish Shanbhag – none

Richard Ambinder – support from Bristol Myers Squib, Celgene

Figures

Figure I
Figure I
Hodgkin Lymphoma: Relative Survival Rates (%) by Stage and B-Symptoms, Ages 15+, 12 SEER Areas, 1988-2001
Figure II
Figure II
5-year relative survival by year of diagnosis in HL patients 1975 -2013
Figure III
Figure III
Pre-treatment PET/CT scan (a) of a patient with stage IVB HL showing bulky mediastinal disease, neck, axillary, abdominal adenopathy and splenic involvement. After 6 months of chemotherapy the post-treatment PET/CT (b) shows complete metabolic remission with resolution of all PET-avidity and adenopathy.
Figure IV
Figure IV
Pseudo-progression on PET/CT in a patient with relapsed cHL on immunotherapy. (A) PET-CT after 6 months of immunotherapy showing complete remission. 3 months later new PET-avid 1.8 cm adenopathy was seen (B) which resolved on the subsequent scan while continuing the same treatment (C).
Figure V
Figure V
Timeline of landmark developments in Hodgkin Lymphoma (HL) over the last decade. Italicized acronyms indicate journal of publication. BBMT – Biology of blood and marrow transplantation, NEJM – New England journal of medicine, JCO – Journal of clinical oncology
See this image and copyright information in PMC

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