Hodgkin Lymphoma

Hodgkin lymphoma (formerly Hodgkin's disease) in brief

Hodgkin lymphoma is a type of lymph node cancer. It differs from non-Hodgkin lymphomas by the presence of certain cells, the so-called Hodgkin cells (single-nucleated cells) and/or the Reed-Sternberg cells (multi-nucleated cells). Hodgkin lymphoma is one of the most treatable forms of lymph node cancer, especially when it is detected early. In Germany, about 2,500 people are diagnosed with it each year. This makes Hodgkin lymphoma a relatively rare disease. Characteristic of Hodgkin lymphoma are the two periods of life in which it can occur: it particularly often affects young adults between 15 and 35 years of age as well as people over 55.

Hodgkin lymphoma in numbers

New diagnoses per year

about 2,500 in Germany

Typical age peaks

15 to 35 years and over 55 years

Prospects of cure

one of the most treatable forms of lymph node cancer

What exactly is Hodgkin lymphoma?

Hodgkin lymphoma (HL) is a malignant disease of the lymphocytes, a special group of white blood cells. There are two main types of Hodgkin lymphoma: 1) classical Hodgkin lymphoma (cHL) and 2) nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). Classical Hodgkin lymphomas make up about 95 % of cases and are divided into four further subtypes. Typically, Hodgkin lymphoma begins in one lymph node region (e.g. the armpit region) and spreads from there to other lymph node regions (e.g. the groin region) or organs.

Why do I have Hodgkin lymphoma?

The exact cause of Hodgkin lymphoma is not fully understood. However, there are some risk factors that can increase the risk of developing it, including:

• A weakened immune system
• A previous infection with the Epstein-Barr virus (EBV)
• A family history of lymphomas

Although these factors can increase the risk, this does not mean that everyone with these risk factors will necessarily develop Hodgkin lymphoma.

Symptoms of Hodgkin lymphoma

Typical symptoms of Hodgkin lymphoma include (individually or in combination):

• Painless swelling of the lymph nodes, usually in the neck, armpit or groin area
• Unintended weight loss (more than 10 %)
• Fever and/or night sweats
• Persistent tiredness or exhaustion
• Itching all over the body
• Alcohol pain (pain in lymph node regions after drinking alcohol)
• Cough, chest pain or breathing difficulties (when the lymphoma affects the chest); these can be intermittent or persistent

These symptoms can also point to other illnesses, which is why it is important to see a doctor if you notice any signs.

When is Hodgkin lymphoma treated?

Treatment of Hodgkin lymphoma is usually started as soon as the diagnosis is confirmed. The diagnosis is confirmed by a biopsy of a lymph node (removal of a lymph node or a puncture). This is particularly important because early treatment significantly increases the chances of a cure. The treatment depends on the stage of the disease, the patient's general state of health and other individual factors.

How is Hodgkin lymphoma treated?

There are several established treatment methods for Hodgkin lymphoma. These depend on the stage of the disease and are sometimes combined:

• Chemotherapy: A combination of medicines that kill cancer cells.
• Radiotherapy: High-energy rays are used to destroy the cancer cells.
• Immunotherapy: New treatment approaches that strengthen the immune system to fight the cancer (depending on the stage of the disease, these are already used today).
• Stem cell transplantation: In advanced cases, a transplant of healthy stem cells may be necessary.

The treatment plan is set individually in order to achieve the best results for the patient.

How have clinical trials changed the treatment of Hodgkin lymphoma?

The German Hodgkin Study Group has made a decisive contribution to improving the treatment of Hodgkin lymphoma since the 1970s and has thereby helped to shape the treatment standard worldwide. Through its clinical trials, the study group has helped to make Hodgkin lymphoma so treatable today and has made it possible to reduce the toxicity of the treatment in recent years.

Optimising chemotherapy – ABVD and BEACOPP

• HD9 trial: In the 1990s, this trial showed that a more intensive chemotherapy called BEACOPP is very effective for patients with advanced Hodgkin lymphoma. It led to higher chances of cure compared with the previous standard therapies. This treatment is more intensive, but very successful in more severe cases of the disease.
• HD10 and HD11 trials: These investigated whether a less intensive chemotherapy (ABVD) is sufficient for patients in early stages of Hodgkin lymphoma. The results showed that ABVD works just as well and places less strain on patients.

Reducing radiotherapy

• HD10 trial: This trial found that in early stages of Hodgkin lymphoma, radiotherapy can be reduced from 30 to 20 Gray (a unit of measurement for the radiation dose) without impairing the chances of a cure. This means less radiation exposure and therefore a lower risk of long-term consequences.
• HD15 trial: For patients with advanced Hodgkin lymphoma, this trial showed that when there is a good response to chemotherapy, radiotherapy can either be reduced or omitted entirely, in order to avoid later side effects such as heart problems or second cancers.

Risk stratification and tailored therapies

• HD14 trial: This trial investigated whether patients with intermediate risk (neither early nor advanced stage) benefit from a more intensive chemotherapy. It was shown that a somewhat more intensive therapy works better in these cases without significantly increasing the side effects.
• HD18 trial: This trial used special PET scans to assess the success of treatment early on. Patients whose initial treatments responded well were able to forgo further, more intensive therapy. In this way, the treatment was better adapted to the individual situation of the patient.

Long-term follow-up and survival rates

• HD13 trial: This trial followed patients who were treated with a less intensive chemotherapy and radiotherapy over a long period. The results showed that these gentler treatments work just as well in early stages and have fewer long-term side effects.