Pathophysiology
Classical HL: CD30+ CD15+ Reed-Sternberg cells derived from crippled germinal-centre B cells within an inflammatory infiltrate. EBV is present in ~40% of mixed-cellularity cases. Nodular lymphocyte-predominant HL is CD20+ CD30- and behaves indolently.
Sources: NCCN Hodgkin Lymphoma (v2.2025); ESMO Hodgkin Lymphoma Guideline (Ann Oncol 2018;29:iv19); NEJM SWOG S0816 & ECHELON-1
Clinical presentation
Painless cervical/supraclavicular lymphadenopathy, mediastinal mass causing cough or SVC syndrome, B symptoms (fever, drenching night sweats, weight loss >10% in 6 mo), pruritus, and pain in involved nodes after alcohol (classic but rare).
Diagnosis
Excisional lymph-node biopsy (needle inadequate). Staging: PET-CT (Ann Arbor/Lugano) and bone marrow biopsy only if PET indeterminate. Prognostic index (IPS) for advanced disease.
Management
Early favourable: 2 cycles ABVD + 20 Gy involved-site RT. Early unfavourable: 4 cycles ABVD + 30 Gy RT. Advanced: 6 cycles A+AVD (brentuximab vedotin + AVD) or escalated BEACOPP; PET-adapted therapy de-escalates bleomycin. Relapsed/refractory: salvage chemo + autologous stem cell transplant; nivolumab or pembrolizumab for post-transplant relapse.
Late effects
Anthracycline cardiotoxicity, bleomycin pulmonary fibrosis, secondary breast/thyroid cancer after mediastinal RT (screen women from 8 y post-RT), infertility, and hypothyroidism.
