Question

Topic is Hodgkins Lymphoma

Discuss the usual degree of severity (i.e., short- and long-term limitations) and prognosis for recovery.

Answer 1

Hodgkins disease: It is characterized by abnormal growth of cells in lymphatic system with potential to invade other parts or organs of the body.

Hodgkins lymphoma usually affects people 15 to 30 years and over 55 years .Hodgkins lymphoma usually starts affecting B lymphocytes.

Types

• Classic hodgkins lymphoma
• Nodular lymphocyte predominant hodgkins lymphoma.

Stage 1&2 Hodgkins lymphoma not large , occurring in less than three lymph nodes, without any systemic symptoms like fever, night sweats, and weight loss and ESR is not elevated then it can be treated with chemotherapy (usually 2 to 4 cycles), followed by radiation to the initial site of the disease or involved site radiation therapy.High-dose chemotherapy followed by a stem cell transplant may be recommended in patients who donot respond to the treatment.

Hodgkins in initial stage may be large with three or more lymph node or extranodal involvement accompanied by systemic symptoms with high ESR is treated with 4 to 6 cycles of chemotherapy ,involved field radiation therapy and  monoclonal antibody brentuximab vedotin can be given.

The 5-year survival rate for people with stage I Hodgkin lymphoma is about 90%. For stage II Hodgkin lymphoma, the 5-year survival rate is about 90%

Stage 3&4 Hodgkins lymphoma is metastatic, affecting one or more organs outside the lymph system.Treatment involves  chemotherapy using more intense regimens generally 6 cycles and high dose chemotherapy is also recommended.If patient is not responding then an immunotherapy drug such as nivolumab (Opdivo®) or pembrolizumab (Keytruda®) might be useful.Chemotherapy and  autologous stem cell transplant may be recommended in case of relapse of HL after treatment.

The 5-year survival rate for stage III Hodgkin lymphoma is about 80%. Stage IV Hodgkin lymphoma has a 5-year survival rate of about 65%.(https://www.cancer.org/cancer/hodgkin-lymphoma/treating/by-stage.html)

Prognosis can be favourable and towards recovery if the patient with hodgkins lymphoma donot has the following characteristics.

• fever,weight loss, or large tumour,
• not older than 45 and male
• WBC more than 15000
• RBC below 10.5
• Lymphocyte count below 600
• High erythrocyte sedimentation rate, or ESR (over 30 in someone with systemic symptoms, or over 50 for someone without systemic symptoms)

Prognosis of stage 4 HL is very low and in stage 1& 2 prognosis may be good.Consolidation therapy is used to kill any cancer cells that may be left in the body. It may include radiation therapy, a stem cell transplant, or treatment with drugs that kill cancer cells is found effective in HL